Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 May 14;12(5):e5802.
doi: 10.1097/GOX.0000000000005802. eCollection 2024 May.

Implant Texture and Capsular Contracture: A Review of Cellular and Molecular Pathways

Hannah J Wells  1 , Jenny C C Yang  1 , Leah Edelstein-Keshet  2 , Kathryn V Isaac  1
Affiliations

Implant Texture and Capsular Contracture: A Review of Cellular and Molecular Pathways

Hannah J Wells et al. Plast Reconstr Surg Glob Open. .

Abstract

Background: Capsular contracture (CC) is a leading cause of morbidity in implant-based breast surgery. Implant surface texture has been implicated in CC development, yet its etiopathogenesis remains unclear. We conducted a systematic review to determine the influence of implant surface texture on cellular and molecular mechanisms involved in the etiopathogenesis of CC.

Methods: A systematic review of the MEDLINE, Embase, Web of Science, and Scopus databases was completed to examine the influence of implant texture on cellular and molecular pathways leading to CC. Excluded articles were reviews and those examining solely the clinical presentation of CC.

Results: Development of CC includes prolonged inflammation, increased myofibroblast density, parallel arrangement of collagen fibers, and biofilm formation. When compared with textured implants, smooth implants are associated with reduction in parallel collagen, capsule thickness, and sheer frictional force. Microtextured implants trigger a reduced macrophage response and decreased fibroblast activation as compared with smooth and macrotextured surfaces. Bacterial counts on microtextured and smooth surfaces are significantly lower than that of macrotextured surfaces. Both micro- and macrotextured implants have increased matrix metalloproteinases and activation of tumor necrosis factor α pathway, with increased activation of the transforming growth factor β1 pathway relative to smooth implants.

Conclusions: Implant surface texture alters the cellular and molecular mechanisms in the chronic inflammatory process leading to CC. Given the complex biological system of cellular and molecular events in CC, a mathematical model integrating these influences may be optimal to deduce the etiopathogenesis.

PubMed Disclaimer

Conflict of interest statement

The authors have no financial interest to declare in relation to the content of this article.

Figures

Fig. 1.
Fig. 1.
Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) flow diagram demonstrating the number of articles screened and removed. After final review, 74 articles remained for final inclusion and data extraction. Adapted from Page et al.
Fig. 2.
Fig. 2.
Cellular and molecular players involved in the development of CC. IFN, interferon. Created with BioRender.com.
Fig. 3.
Fig. 3.
Summary of differences in cellular and molecular processes leading to CC in smooth vs textured implant surfaces. Created with BioRender.com.
See this image and copyright information in PMC

References

    1. Glicenstein J. Histoire de l’augmentation mammaire. Annales de Chirurgie Plastique Esthétique. 2005;50:337–349. - PubMed
    1. Jones P, Mempin M, Hu H, et al. . The functional influence of breast implant outer shell morphology on bacterial attachment and growth. Plast Reconstr Surg. 2018;142:837–849. - PubMed
    1. Domanskis E, Owsley JQ. Histological investigation of the etiology of capsule contracture following augmentation mammaplasty. Plast Reconstr Surg. 1976;58:689–693. - PubMed
    1. Safran T, Nepon H, Chu CK, et al. . Current concepts in capsular contracture: pathophysiology, prevention, and management. Semin Plast Surg. 2021;35:189–197. - PMC - PubMed
    1. Spear SL, Mesbahi AN. Implant-based reconstruction. Clin Plast Surg. 2007;34:63–73; abstract vi. - PubMed