Plastic Surgery Research Council
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Presenter: Justin R Fernandes, MD
Co-Authors: Salinas HM; Broelsch GF; McCormack MC; Meppelink AM; Randolph MA; Redmond RW; Austen WG, Jr
Massachusetts General Hospital

Purpose: Capsular contracture is the most common complication following augmentation mammoplasty with prosthetic implants. Within a decade of surgery, half of patients develop capsular contracture, which may lead to significant morbidity and the need for re-operation. Currently, there is no preventative treatment available and the recurrence rate remains high, even after capsulectomy. Photochemical tissue passivation (PTP) is a novel tissue-stabilization technique, which reduces post-surgical inflammation, and prevents the development of pathogenic collagen bundles following surgery. By using this therapy to passivate the collagenous tissues of the implant pocket, we hope to prevent capsule formation and subsequent contracture.

Methods: Utilizing a previous published model of capsular contracture, six cubic centimeter tissue expanders where placed under the skin and subpaniculus carnus muscle along the dorsum of New Zealand white rabbits. Treated pockets received photochemical tissue passivation by coating them with a photosensitizing dye and exposing the area to a 532nm laser for 3 minutes. Fibrin glue was instilled into each implant pocket to induce contracture. After 8 weeks, capsule tissue was harvested for histology.

Results: The photochemical tissue passivation group had a 50% decrease in capsule thickness when compared to the controls. Implant capsule thickness is the number one prognostic factor for contracture development. The treated pockets also demonstrated decreased inflammation and vascularity within the capsule. PTP resulted in less fibrohistiocystic cells, macrophages and synovial metaplasia.

Conclusions: PTP significantly decreased both capsule thickness and the inflammatory response after prosthetic implantation. When performed at the time of surgery, this is a simple and promising technique for the prevention of capsular contracture. This novel therapy could potentially decrease morbidity, prolong implant lifespan, and decrease health care costs.

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