Collagen coatings reduce the incidence of capsule contracture around soft silicone rubber implants in animals

Silicone rubber miniprostheses known to be associated with a high rate of experimental capsule contracture were implanted subcutaneously in rats. Prostheses were coated either with 2 layers of collagen cross-linked with formaldehyde or with 1 layer of collagen cross-linked with glutaraldehyde. Noncoated prostheses were implanted as controls. Contracture was defined as grossly observable distortion of the implant mounds from round to avoid. Capsules were examined histologically at explant at 255 days. In the control group with no coating present capsules formed very early in 100% of the implants. The group with a 2-layer, formaldehyde-treated collagen coat demonstrated the greatest total surface area covered with coating, the least degree of capsule formation, the lowest rate of contracture (7%), and the longest onset. The group with a single layer of collagen treated with glutaraldehyde showed an intermediate coverage of coating, an intermediate degree of capsule formation, an intermediate contracture rate (50%), and an intermediate time of onset. These observations confirm earlier results by showing a correlation between intact collagen coating and absence of capsule formation, and also further demonstrate a significant reduction in the rate of capsule contracture for collagen-coated implants.     

The presence of silicone in breast capsules

The presence of silicon-containing compounds in the capsules of women undergoing secondary surgical procedures has been identified by energy dispersion X-ray analysis. The birefringence and surface configuration qualities have been examined by polarized light-microscopic and electron-microscopic methods. The data indicate that silicone polymer (polydimethyl siloxane) is present both within cells and in the intercellular matrix of the capsule; the source of this material is the silicone gel-filled implant. A histiocytic and foreign-body giant-cell response was found to be associated with the silicon-containing compounds. It remains conjectural whether this chronic response is associated with the pain present in significant breast capsule formation.Presented in part at the Plastic Surgery Research Council, May 1978, Richmond, Virginia.Division of Plastic and Reconstructive Surgery.Departments of Pathology and Biomedical Engineering.     

Screw fixation of silicone implants

A simple and safe procedure for fixation of silicone prostheses is presented. Two screws ensure accurate location, helping to avoid displacement and probably reducing the incidence of bone damage.     

Histological analysis of capsule formation around silicone implants and comparison with titanium-coated silicone implants in rats

Silicone implants have been used for breast augmentation for more than 45 years. Complications, in particular capsular contracture, occur with an incidence of <10% and up to 60%. We investigated the influence of the surface of breast implants on the formation of capsular contracture by comparing silicone with titanium-coated silicone. Seventeen smooth saline-filled silicone (group A) and 14 saline-filled titanium-coated silicone (group B) implants were implanted in female Wistar rats. After 12 and 36 weeks, the implants and capsules were extracted; histological and immunohistochemical staining was performed. The evaluation of the capsules was performed by two examiners in a double-blinded manner. Histologically, no significant difference in total capsule thickness was found. There was a significant difference in synovial-like metaplasia layer (SLM) thickness between groups A and B (p = 0.041). Regarding implantation time (12 vs. 36 weeks), a significant difference was found in SLM thickness (p = 0.021). Immunohistochemical staining indicated a significantly lower infiltration with inflammatory cells in group B. A significant correlation (p = 0.019) between a thick SLM layer and inflammatory cell infiltration was detected. Titanium-coated silicone implants reduce SLM thickness and capsular inflammatory cell infiltration. These findings postulate that titanium-coated silicone implants might point out a new chance in the prevention of capsular contracture.     

Subcutaneous silicone implants in pectus excavatum

In seventeen patients presenting funnel chest a subcutaneous implantation of silicone prostheses was performed. In nine patients seromas were aspirated postoperatively. Five patients were reoperated, one for correction of a displacement of the prosthesis, one for size reduction and one for implant removal, because of various complaints not related to the prosthesis. At the final evaluation sixteen out of seventeen patients expressed satisfaction with the result.     

Reaction to silicone implants in the guinea pig

Many papers have been published on the lack of reaction around silicone implants both in the experimental animal and the human. A study with human silicone implants with silicone gel interior shows loss of the silicone fluid from intact silicone sac. A solid silicone disc subjected to 5 pounds weight for one week loses silicone to the underlying paper. In the guinea pig, some capsules surrounding solid silicone implants, silicone sacs with saline, and silicone sac with silicone gel show vacuole or amorphous materials (silicone) with a thickening of the capsule and associated inflammatory reaction. These vacuoles or amorphous material resembles the silicone found in capsules around intact human silicone jell prosthesis. The presence of silicone with associated thickening of the capsule and inflammatory reaction may be one cause of firmness in the human after breast augmentation by silicone implants.     

The art of custom silicone implants for difficult deformities

Patients who present for unilateral correction of anatomical deformities require development of a mirror image prosthesis. Moulage casting techniques offer a viable option for accurate design from which a custom implant can be fashioned, allowing surgeons to place a device that is unique to each patient's needs. The authors discuss the advantages of working with an experienced artist to develop these castings and present two cases of successful implantation after moulage casting.     

Structure of the capsules around silicone elastomer implants

Summary Experiments were carried out on rats to determine tissue reactions to silicone rods and sheeting for up to 8 months after implantation. The connective tissue capsule forming around an implant within a few weeks is a structure well supplied with blood vessels which has an inner lining of fibrocytes and histiocytes. A typical feature of the capsules, at any time during the experimental period, was the presence of variable numbers of histiocytes in the capsule wall, in conjunction with different degrees of vascularization. Encapsulation of silicone implants does not lead to a steady state, the capsule remaining an unstable, reactive membrane.     

The long-term results of Swanson silicone rubber interpositional wrist arthroplasty

Fifty-three Swanson silicone rubber interpositional wrist arthroplasties were done in 42 patients. A painful rheumatoid wrist was the most common operative indication. Very acceptable clinical results were obtained early in follow-up, with more than 90% of the wrists obtaining significant pain relief. However, in the group of wrists followed for more than 2.5 years, only 61% had good or excellent results. The reoperation rate in this group was 25%. Postoperative complications included prosthetic breakage (9.4%), ulnar cap breakage (71%), and a very high incidence of progressive radiographic deterioration (70%).     

硅胶假体与膨体聚四氟乙烯并用隆鼻术治疗鼻尖过低

目的探讨硅胶假体与膨体聚四氟乙烯并用隆鼻术治疗鼻尖过低、鼻孔显露整形的手术方法,以减少传统手术方法的并发症.方法在鼻硅胶假体上的鼻尖部附加一膨体聚四氟乙烯补片,用5-0尼龙线将两者缝合固定后行隆鼻术.结果硅胶假体与膨体聚四氟乙烯并用为228例患者行隆鼻术,并治疗鼻尖过低、鼻孔显露.术后随访3个月至2年,满意者225例,占98.68%;鼻尖发红者3例,占1.32%,其中取出鼻假体于3个月后再次行隆鼻术者2例,于2周后修整膨体聚四氟乙烯补片厚度者1例,术后效果较理想.结论硅胶假体与膨体聚四氟乙烯并用隆鼻术,是治疗鼻尖过低、鼻孔显露有效的手术方法.     

硅胶假体与膨体聚四氟乙烯并用隆鼻术治疗鼻尖过低

目的探讨硅胶假体与膨体聚四氟乙烯并用隆鼻术治疗鼻尖过低、鼻孔显露整形的手术方法，以减少传统手术方法的并发症。方法在鼻硅胶假体上的鼻尖部附加一膨体聚四氟乙烯补片，用5-0尼龙线将两者缝合固定后行隆鼻术。结果硅胶假体与膨体聚四氟乙烯并用为228例患者行隆鼻术，并治疗鼻尖过低、鼻孔显露。术后随访3个月至2年，满意者225例，占98．68％；鼻尖发红者3例，占1．32％，其中取出鼻假体于3个月后再次行隆鼻术者2例，于2周后修整膨体聚四氟乙烯补片厚度者1例，术后效果较理想。结论硅胶假体与膨体聚四氟乙烯并用隆鼻术，是治疗鼻尖过低、鼻孔显露有效的手术方法。