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Vicryl Wrapping Implants Induces Favorable Capsular Microtopography to Improve Implant Stability
Tim Y. Li
*, Jini Jeon, Riley Mayne, Sophia Salingaros, Hector Salazar Martinez, Xue Dong, Jason A. Spector
Weill Cornell Medical College, New York, NY
BACKGROUNDUse of textured breast implants and tissue expanders has markedly declined due to their association with BIA-ALCL. Alternatives such as ADM are costly, and suture tabs for expander anchoring can cause pain and anchor point failure, followed by implant malposition. Our previous work and recent clinical data suggest that wrapping smooth implants with absorbable Vicryl mesh can decrease rotation. This study aims to investigate factors contributing to the enhanced stability of Vicryl wrapped implants.
METHODSMiniature breast implants were manufactured using polydimethylsiloxane. Woven Vicryl mesh was used to wrap smooth implants, with comparison groups consisting of smooth and textured implants. Six sterilized implants from each group were implanted into subcutaneous pockets on the dorsa of Sprague-Dawley rats. Animals were sacrificed at 4 and 12 weeks, and implant-capsule units were explanted for evaluation of positional stability, histology, and SEM.
RESULTSVicryl wrapped implants rotated 49 degrees less than smooth implants at 4 weeks, and 76 degrees less at 12 weeks (
p>0.05). Histology demonstrated partially dissolved Vicryl mesh in the wrapped group at 4 weeks, with no evidence of remaining mesh at 12 weeks. There were no significant differences in capsule thickness and collagen fiber density (percent area) between smooth and wrapped conditions. Although histologically similar, on higher magnification SEM demonstrated a regular pattern of undulating microscopic projections in wrapped implant capsules, recapitulating the woven patterns of Vicryl mesh; smooth implant capsules were largely featureless.
CONCLUSIONImplants wrapped with fast-absorbing Vicryl mesh demonstrated improved stability, likely due to capsular microtopographic changes (seen only on SEM) induced by the presence of Vicryl mesh, resulting in increased frictional force between the implant surface and surrounding tissues. This study highlights the potential of Vicryl mesh as an affordable, temporary scaffold for stabilizing smooth breast implants.
Figure: Scanning electron microscopy images of different capsule surface microtopographies for smooth and Vicryl wrapped miniature silicone breast implants. Wrapped implant capsules demonstrated protruding features 321.7±41.2µm in diameter and 71.9±13.7µm in height with density of 12 features per 1mm2, whereas smooth implant capsules were largely featureless. The small round bubble-like structures among the larger features represent an oil artifact from tissue processing.
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