Aesthet Surg J. 2024 Aug 20;44(9):915-924. doi: 10.1093/asj/sjae057.
Polyurethane (PU)-coated breast implants are known for their strong integration into breast tissue and the formation of capsules around them. However, capsular contracture can pose both aesthetic and clinical challenges.
The objectives of this study were to analyze the biological and morphological characteristics of the capsular tissue surrounding PU-coated implants, irrespective of their contracture status, and to assess their potential suitability as a flap in revisional breast surgery for capsular contracture.
A total of 23 tissue samples were harvested from the capsules surrounding PU-coated breast implants in 12 female patients during replacement or revisional surgery. We evaluated collagen abundance, cellular and vascular density, inflammation, collagen band types and alignment, synovial metaplasia, capsule thickness, and the expression of inflammatory biomarkers and myofibroblasts with immunohistochemical techniques. Scanning electron microscopy was employed to assess implant surface characteristics over time.
We found a significant association of capsule contraction with longer implantation durations and greater implant surface roughness (P = .018 and P = .033, respectively). Synovial metaplasia was significantly more frequent in noncontracted capsules (P = .0049). Both capsule types consisted of paucicellular, type I collagen-rich compact fibrous tissue with low vascularization. There was a marked reduction in inflammatory cells within the foreign body granuloma. The expression of inflammatory biomarkers in the capsular tissue was negligible.
Given the reduced levels of inflammatory and vascular components within the dense, fibrous capsular tissue, we consider them to be viable alternatives for capsular flaps in revisional surgery. This strategy has the potential to mimic the reconstruction achieved with acellular dermal matrix.
聚氨基甲酸乙酯（PU）涂层乳房植入物以其与乳房组织的紧密结合以及在其周围形成包膜而闻名。然而，包膜挛缩会带来美观和临床方面的挑战。
本研究旨在分析无论是否存在挛缩，PU 涂层植入物周围包膜组织的生物学和形态学特征，并评估其作为包膜挛缩修复性乳房手术皮瓣的潜在适用性。
在 12 名女性患者的更换或修复手术中，从围绕 PU 涂层乳房植入物的包膜中采集了总共 23 个组织样本。我们采用免疫组织化学技术评估了胶原含量、细胞和血管密度、炎症、胶原带类型和排列、滑膜化生、包膜厚度以及炎症标志物和肌成纤维细胞的表达。扫描电子显微镜用于评估植入物表面特征随时间的变化。
我们发现包膜收缩与植入时间较长和植入物表面粗糙度较大显著相关（P =.018 和 P =.033）。未挛缩包膜中的滑膜化生更为频繁（P =.0049）。两种包膜类型均由细胞稀疏、富含 I 型胶原的致密纤维组织组成，血管化程度较低。异物肉芽肿内的炎症细胞明显减少。包膜组织中炎症标志物的表达可忽略不计。
鉴于致密纤维包膜组织内炎症和血管成分水平降低，我们认为它们是修复性手术中包膜皮瓣的可行替代品。这种策略有可能模仿脱细胞真皮基质重建的效果。
