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Submuscular Placement of Positionally Stable Smooth Implants
Tim Y. Li
*, Riley Mayne, Jini Jeon, Sophia Salingaros, Matthew W. Liao, Samuel Medina, Xue Dong, Jason A. Spector
Weill Cornell Medical College, New York, NY
BACKGROUNDTextured implants have been voluntarily recalled due to their link with BIA-ALCL, resulting in the loss of the major benefits conferred by the textured surface—positional stability. This loss is particularly significant in submuscular breast implant placement, which is prone to muscle contraction-induced displacement. To address this challenge, we developed the Positionally Stable Smooth Implant (PSSI), featuring cylindrical wells on the surface to promote tissue ingrowth and stabilize the implant. This pilot study aimed to assess positional stability of the PSSI in a rodent submuscular model and characterize capsule formation around the implant.
METHODSMiniature breast implants were fabricated using polydimethylsiloxane. The PSSI implants, with 52 wells each measuring 2mm in diameter and 1mm in depth, were compared to smooth implants as controls. Four implants per group were placed under the latissimus dorsi muscle on the bilateral dorsa of Sprague-Dawley rats. Implant position was evaluated with microCT at 0, 2, and 6 weeks. Animals were sacrificed at 6 weeks, and capsular histology was analyzed.
RESULTSPSSI implants exhibited a cumulative rotation of 49.1±29.2 degrees, significantly less than smooth implants at 156.0±34.6 degrees (
p<0.05). MicroCT revealed tissue infiltration into PSSI wells as early as week 2. PSSI capsules demonstrated tissue ingrowth conforming to the cylindrical wells. Trichrome staining illustrated parallel collagen fiber alignment in capsules surrounding smooth implants and non-well regions of PSSI, while collagen fibers within PSSI wells appeared less organized, contouring to the surface morphology. There was no significant difference in capsule thickness between groups (
p>0.05).
CONCLUSIONGross and histological findings demonstrated robust capsular ingrowth into the PSSI wells within the submuscular plane, effectively anchoring the implant to the surrounding tissues. These results suggest a promising alternative to textured surface for achieving positional stability in patients undergoing submuscular implant placement.
Figure 1: (A) Top: identification and elevation of latissimus dorsi muscle, with dashed white line demarcating the muscle border; Bottom: latissimus dorsi tacked down to chest wall, with white arrow indicating implant under the muscle. (B) PDMS implant, gross evaluation of peri-implant capsule, and trichrome (40x) staining of capsule. (C) Cumulative implant rotation weeks 0-6, and capsule thickness quantification. *p<0.05.
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