Plastic Surgery Research Council
Members Only  |  Contact  |  PSRC on Facebook

Back to Annual Meeting Program


ESTROGEN RECEPTORS ALPHA AND BETA EXPRESSION IN BREAST IMPLANT CAPSULES: EXPERIMENTAL FINDINGS AND CLINICAL CORRELATES
Presenter: Francesco Segreto, MD
Co-Authors: Carotti S; Marangi GF; Tosi D; Morini S; Persichetti P
Campus BioMedico di Roma University

Capsular contracture is a common complication of breast heterologous reconstruction and augmentation; pregnancy has been reported to be a risk factor. Myofibroblasts provide a force to decrease the surface area of the capsule as the collagen matrix matures. In other tissues, seventeen-Œ?-estradiol has been shown to promote myofibroblasts contraction and differentiation by mean of TGFŒ≤-Œ?. Inversely, tamoxifen reduces TGFŒ≤-Œ? production and myofibroblast contraction. The aim of the study was to investigate the expression of Estrogen Receptors Œ± and Œ? in capsular tissue. The study enrolled 70 women (80 capsules) who underwent expander or implant removal following breast reconstruction. Specimens were stained with Hematoxylin/Eosin, Masson trichrome, immunohistochemistry and immunofluorescence for alpha-Smooth Muscle Actin (Œ±-SMA), Estrogen Receptor-alpha (ER-Œ?) and Estrogen Receptor-beta (ER-Œ?). A positivity score was assigned. The relationship between anti-estrogenic therapy and capsular severity was evaluated. A retrospective analysis of 233 cases of breast reconstruction was performed. Myofibroblasts expressed ER-Œ±, ER-Œ? or both. In the whole sample, Œ±-SMA score positively correlated with ER-Œ± (p=0.022) and ER-Œ? expression (p<0.004); ER-Œ? expression negatively correlated with capsular thickness (p<0.019). In capsules surrounding expanders Œ±-SMA and ER-Œ± expressions positively correlated each other (p=0.017) and negatively correlated with time from implantation (p=0.002 and p=0.016, respectively). The incidence of grade III-IV contracture was higher in patients who did not have anti-estrogenic therapy (p<0.036). Retrospective analysis of 233 cases confirmed this finding (p<0.0001): the intake of tamoxifen, aromatase inhibitors or combination of tamoxifen and GnRH-analogues was associated to lower contracture severity (p<0.0001, p=0.001 and p=0.001, respectively). This study demonstrates the expression of estrogen receptors in myofibroblasts of capsular tissue and a lower contracture severity in patients undergoing anti-estrogenic therapy, thus providing new evidences about the underlying pathogenic pro


Back to Annual Meeting Program