This paper is only available as a PDF. To read, Please Download here.
Abstract
The occurrence, structure and contractility of myofibroblasts in the capsules around tissue expanders and static implants has been studied in the rat, pig and humans. The capsules showed a characteristic layered structure with myofibroblasts being the predominant cell type. Capsular strips contractin vitro in a manner characteristic of fibroblast contraction. The contractile ability decreased with the time since expander insertion; and increased with expander exposure, peri-expander infection and clinical evidence of adverse capsular contracture. An hypothesis is proposed that capsular contracture is analogous to wound contraction, and that intraimplant pressure usually inhibits capsular contraction. Evidence is shown from intraexpander pressure measurements to support this hypothesis. The clinical implications for tissue expansion and breast augmentation are discussed.
Reference
- The complications of tissue expansion in breast reconstruction: a review of 75 cases.Br J Plast Surg. 1987; 40: 629-635
- Capsular contracture after breast reconstruction with tissue expansion.Br J Plast Surg. 1989; 42: 591-594
- Capsular contracture: hard breasts, soft data.Clin Plast Surg. 1988; 15: 521-532
- Granulation tissue as a contractile organ: a study of structure and function.J Exp Med. 1972; 135: 719-734
- The life cycle of the myofibroblast.Surg Gynecol Obstet. 1977; 145: 389-394
- The observation of myofibroblasts in hypertrophic scars.Surg Gynecol Obstet. 1975; 141: 22-26
- The ultrastructure of a keloid.J Am Acad Dermatol. 1980; 3: 50-57
- Dupuytren's contracture: fibroblast contraction? an ultrastructural study.Am J Pathol. 1972; 66: 131-146
- Desmoid tumors, an ultrastructural study of eight cases.Hum Pathol. 1980; 11: 43-50
- The myofibroblast: biologic, pathologic, and theoretical considerations.Pathol Annu. 1980; 15: 443-470
- Myofibroblasts in human granulation tissue.Hum Pathol. 1974; 5: 55-67
- Wound contraction and fibrocontractive disorders.Arch Surg. 1978; 113: 1034-1046
- Myofibroblasts and free silicon around breast implants.Plast Reconstr Surg. 1978; 62: 185-196
- Myofibroblasts in connective tissue capsules around implanted dental materials.Exp Pathol. 1980; 18: 31-36
- Effect of implant location on compressibility and capsule formation around miniprostheses in rats, and experimental capsule contracture.Ann Plast Surg. 1981; 6: 182-192
- Presence of modified fibroblasts in granulation tissue and their possible role in wound contraction.Experientia. 1971; 27: 549-550
- Contraction of granulation tissuein vitro: similarity to smooth muscle.Science. 1971; 173: 548-550
- The technique of superfusion.Br J Pharmacol. 1953; 8: 321-326
- Objective monitoring for safe tissue expansion.Plast Reconstr Surg. 1986; 77: 416-420
- Augmentation mammaplasty.in: Grabb WC Smith JW Plastic Surgery. 3rd ed. Little Brown, Boston1979: 719-736
- Anin vitro investigation into the nature of myofibroblast contractility.in: PhD Thesis. University of Bradford, Bradford, England1987
- Electron microscopic evaluation of guinea pig skin and soft tissues “expanded” with a self-inflating silicone implant.Plast Reconstr Surg. 1982; 70: 37-45
- Histomorphic evaluation of guinea pig skin and soft tissue after controlled tissue expansion.Plast Reconstr Surg. 1982; 70: 704-710
- Study of encapsulation of silicone rubber implants in animals.Plast Reconstr Surg. 1978; 62: 580-588
- Does infection play a role in breast capsular contracture?.Plast Reconstr Surg. 1981; 68: 34-42
- Capsular contracture around silicone implants: the role of intraluminal antibiotics.Plast Reconstr Surg. 1982; 69: 809-814
- Role of myofibroblasts in pseudointima formation.Surgery. 1983; 94: 792-807
- Altered β-actin gene expression in phorbol myristate acetate-treated chondrocytes and fibroblasts.Mol Cell Biol. 1985; 5: 1425-1433
- Histopathology of human expanded tissue.Clin Plast Surg. 1987; 14: 435-445
- A histological comparison of contracted and noncontracted capsules around silicone breast implants.Plast Reconstr Surg. 1979; 63: 700-707
- The nature of the collagenous capsules around breast implants.Plast Reconstr Surg. 1979; 64: 456-464
- Occurrence and activity of myofibroblasts in human capsular tissue surrounding mammary implants.Plast Reconstr Surg. 1981; 68: 905-914
- The fibrous capsules around static and dynamic implants: their biochemical, histological, and ultrastructural characteristics.Ann Plast Surg. 1987; 19: 208-216
- The effect of mechanical stress on soft and hard tissue repair; a review.Br J Plast Surg. 1988; 41: 182-186
- Capsular contracture in breast augmentation: a return to the good old days.Br J Plast Surg. 1982; 35: 374-375
- The incidence of experimental contracture varies with the source of the prosthesis.Plast Reconstr Surg. 1985; 75: 668-675
- Objective clinical assessment of fibrous capsular contracture.Plast Reconstr Surg. 1982; 69: 794-801
- Accelerated tissue expansion with the “over-filling” technique.Plast Reconstr Surg. 1988; 81: 204-207
- Physical, biomechanical, histologic, and biochemical effects of rapid versus conventional tissue expansion.Plast Reconstr Surg. 1989; 83: 687-691
- Selective use of serial expansion in breast reconstruction.Ann Plast Surg. 1983; 11: 188-195
- Reconstruction of the breast by tissue expansion.Clin Plast Surg. 1984; 11: 257-264
- Soft-tissue expander for delayed and immediate breast reconstruction.Surg Clin North Am. 1985; 65: 383-391
- Use of a permanent tissue expander for breast reconstruction.Plast Reconstr Surg. 1989; 84: 607-620
- The expandable mammary implant.Plast Reconstr Surg. 1987; 79: 631-637
- Immediate breast reconstruction with tissue expansion.Plast Reconstr Surg. 1987; 80: 559-566
- Breast reconstruction by tissue expansion.Ann Roy Coll Surg Eng. 1987; 69: 18-21
- Delay between expansion and expander/implant exchange in breast reconstruction—a prospective study.Br J Plast Surg. 1992; 45: 279-283
- Textured or smooth implants for breast augmentation?.A prospective controlled trial. Br J Plast Surg. 1991; 44: 444-448
Article info
Publication history
Accepted:
June 14,
1993
Received:
March 3,
1993
Identification
Copyright
© 1993 The British Association of Plastic Surgeons. Published by Elsevier Inc.