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Prevention of Capsular Contracture with Photochemical Tissue Passivation

Fernandes, Justin R. M.D.; Salinas, Harry M. M.D.; Broelsch, G. Felix M.D.; McCormack, Michael C. M.B.A.; Meppelink, Amanda M. B.S.; Randolph, Mark A. M.A.S.; Redmond, Robert W. Ph.D.; Austen, William G. Jr. M.D.

Plastic & Reconstructive Surgery: March 2014 - Volume 133 - Issue 3 - p 571–577
doi: 10.1097/01.prs.0000438063.31043.79
Experimental: Original Articles

Background: Capsular contracture is the most common complication following the insertion of breast implants. Within a decade, half of patients will develop capsular contracture, leading to significant morbidity and need for reoperation. There is no preventative treatment available and the recurrence rate remains high. Photochemical tissue passivation is a novel tissue-stabilization technique that results in collagen cross-linking. It can rapidly link collagen fibers in situ, preserving normal tissue architecture. By using this therapy to passivate the collagenous tissues of the implant pocket, the authors hope to prevent the development of pathogenic collagen bundles and subsequent capsule contracture.

Methods: Six–cubic centimeter tissue expanders were placed below the panniculus carnosus muscle along the dorsum of New Zealand white rabbits. Fibrin glue was instilled into each implant pocket to induce contracture. Treated pockets received photochemical tissue passivation by coating them with a photosensitizing dye and exposing the area to a 532-nm light. After 8 weeks, capsule tissue was harvested for histologic evaluation.

Results: Implant capsule thickness is the number one prognostic factor for contracture development. The authors demonstrated a 52 percent decrease in capsule thickness in the passivated group compared with controls. Photochemical tissue passivation resulted in fewer fibrohistiocytic cells and macrophages and in reduced synovial metaplasia and smooth muscle actin deposition.

Conclusions: Photochemical tissue passivation significantly decreased both capsule thickness and smooth muscle actin deposition. It is a promising technique for preventing capsular contracture that can be performed at the time of initial surgery without a significant increase in procedure time.

Boston, Mass.

From the Division of Plastic and Reconstructive Surgery and the Wellman Center for Photomedicine, Massachusetts General Hospital.

Received for publication June 14, 2013; accepted October 2, 2013.

Abstract presented at the 58th Annual Meeting of the Plastic Surgery Research Council, in Santa Monica, California, May 2 through 4, 2013; and the 54th Annual Meeting of the New England Society of Plastic and Reconstructive Surgeons, in Newport, Rhode Island, June 1 through 3, 2013.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. This research was supported by departmental funds.

William G. Austen, Jr., M.D., Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, 15 Parkman Street, WAC 435, Boston, Mass. 02114, wausten@partners.org

©2014American Society of Plastic Surgeons