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Prevention of Capsular Contracture with Photochemical Tissue Passivation
Justin R. Fernandes, MD, Harry M. Salinas, MD, Guenther Broelsch, MD, Amanda M. Meppelink, BS, Michael C. McCormack, MBA, Mark A. Randolph, MAS, Robert W. Redmond, PhD, William G. Austen, Jr., MD.
Massachusetts General Hospital, Boston, MA, USA.
Background: Capsular contracture is the most common complication following both augmentation and reconstruction with prosthetic breast implants. Within a decade of surgery, half of patients develop capsular contracture which may lead to significant morbidity and need for reoperation. Currently, there is no preventative treatment available and the recurrence rate remains high, even after capsulectomy. Photochemical tissue passivation (PTP) is a novel tissue-stabilization technique which results in collagen crosslinking. It has been used to bind and strengthen various tissues including skin and cornea. PTP can rapidly link collagen fibers in situ during implant surgery, preserving normal tissue architecture and preventing the development of pathogenic collagen bundles. By using this therapy to passivate the collagenous tissues of the implant pocket, we hope to prevent capsule formation and subsequent contracture.
Methods: Utilizing a previous published model of capsular contracture, six cubic centimeter tissue expanders where placed under the skin and subpaniculus carnus 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 532nm laser for 3 minutes. After 8 weeks, the implants were overfilled and pressure curves recorded for each. Capsule tissue was harvested for histology.
Results: There were no significant differences in opening pressure or overall pressure curves between each group. We did however, see a 50% decrease in capsule thickness in the passivated group when compared to the controls. Implant capsule thickness is the number one prognostic factor for contracture development. The treated pockets also demonstrated decreased smooth muscle actin deposition, a fiber associated with contracture.
Conclusions: PTP decreased both capsule thickness and the inflammatory response after prosthetic implantation. When performed at the time of surgery, this is a promising technique for preventing capsular contracture.
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