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Positionally Stable Smooth Implants Resist Rotational Forces When Placed in the Submuscular Plane
Sophia Salingaros
*, Matthew W. Liao, Abby Chopoorian Fuchsman, Kate Manley, Tim Y. Li, Samuel Medina, Xue Dong, Jason A. Spector
Weill Cornell Medicine, New York, NY
BACKGROUND: Following the voluntary recall of textured implants due to BIA-ALCL, plastic surgeons lost a major benefit of textured surfaces
"”positional stability. This loss is particularly important in submuscular implant placement, which is potentially at greater risk of displacement from muscle contraction. We have engineered a novel smooth-surface breast implant design featuring millimeter scale cylindrical surface wells to promote tissue ingrowth. We previously reported that these Positionally Stable Smooth Implants (PSSI) demonstrate superior positional stability versus smooth implants (and comparable to textured) in a subcutaneous
in vivo model. Here, we challenge PSSI in a submuscular model.
METHODS: Hemispherical miniature 2cc breast implants were fabricated with polydimethylsiloxane. PSSI implants were designed with wells 2mm wide (W) by 1mm deep (D), with a density of 26, 52, or 70 wells/implant. Miniature smooth and textured implants (salt-loss technique) served as controls. Six implants per group were placed under the bilateral latissimus dorsi muscles of female Sprague-Dawley rats. Implant rotation was evaluated via microCT at 2, 4, 8, and 12 weeks, and explanted at 12 weeks.
RESULTS: Over 12 weeks, PSSI exhibited a cumulative rotation of 42.4±22.3°, significantly less than smooth implants (151.5±32.1°, p<0.001) and comparable to textured implants (25.4±9.8°, p>0.05). Increasing PSSI well density reduced the rotation, though not significantly. Capsules were significantly thicker around textured implants (106um) versus smooth (73um), W2D1(52) (72um) and W2D1(70) (71um) groups (p<0.05). Smooth implant capsules had significantly higher collagen density and smooth muscle actin expression (both potentially involved with capsular contracture) compared to textured and PSSI groups (p<0.05).
CONCLUSION: Tissue ingrowth into PSSI wells resulted in a significant reduction of implant rotation and myofibroblast activity compared to smooth implants. These data suggest PSSI are a promising alternative to texturing for providing submuscular positional stability.
