ABSTRACT
BACKGROUND: 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. OBJECTIVES: 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 revision breast surgery for capsular contracture. METHODS: A total of 23 tissue samples were harvested from the capsules surrounding PU-coated breast implants in 12 female patients during replacement or revision 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 using immunohistochemical techniques. Scanning electron microscopy was used to assess implant surface characteristics over time. RESULTS: We found a significant association of capsule contraction with longer implantation durations and greater implant surface roughness (p = 0.018 and p = 0.033, respectively). Synovial metaplasia was significantly more frequent in noncontracted capsules (p = 0.0049). 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. CONCLUSIONS: Given the reduced levels of inflammatory and vascular components within the dense, fibrous capsular tissue, we consider them to be viable alternatives for use as capsular flaps in revision surgery. This strategy has the potential to mimic the reconstruction achieved with acellular dermal matrix.
ABSTRACT
BACKGROUND: Breast deformities, often attributable to surgical mutilations as a result of mammary carcinoma treatment, still are a challenge to plastic surgeons. Interesting alternatives for the frequently used musculocutaneous flaps are local flaps such as the lateral thoracodorsal flap developed by Holmström in 1986. This flap is simple to raise and involves no sacrifice of important muscular structures. This report aims to demonstrate the use of the modified lateral thoracodorsal flap in an immediate mammary reconstruction for a patient who refused any other scar. METHODS: A case report describes a patient presenting with breast cancer after reduction mammaplasty who was treated with a skin-sparing mastectomy and immediate reconstruction. RESULTS: Satisfactory defect correction was accomplished with adequate silicone implant covering and a natural ptotic breast shape. CONCLUSIONS: The versatility of this flap and its simple execution make it an important option for diverse breast reconstruction situations. The lateral thoracodorsal flap provides aesthetic results similar to those with other reconstruction methods, but without major complexity. The authors believe that it could be an interesting tool for the treatment of a breast anomaly.
