Titanium-coated polypropylene mesh (TiLoop Bra®)—an effective prevention for capsular contracture?
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Silicone implants have been used in breast augmentation for more than 45 years. Complications, in particular, capsular contracture, still occur with a high incidence. Titanium-coated polypropylene mesh (TCPM; TiLoop Bra®, pfm medical, Cologne, Germany) provides new opportunities for implant-based breast reconstruction. We investigated the influence of the surface of silicone implants on the formation of capsular contracture by comparing textured silicone with TCPM-covered smooth silicone implants.
Twenty textured silicone gel-filled (group A) and twenty TCPM-covered smooth silicone gel implants (group B) (Silimed®, Rio de Janeiro, Brazil) were implanted in female Wistar rats. After 60 days, the implants and capsules were extracted, and histological and immunohistochemical staining was performed. The double-blind evaluation of the capsules was performed by two examiners.
We were able to detect a thinner, but stiffer, capsule and a less development of an inner synovia metaplasia layer as well as a lower vascularity in capsules around TCPM-covered silicone implants. We found a higher percentage of myofibroblasts within the capsule structure and more inflammatory cell infiltration.
The quality of capsule structure around both tested implants differs significantly. Although capsules around TCPM-covered implants presented were thinner, they integrated with the mesh in a rigid cage structure capsule with higher infiltration of inflammatory cells caused by a significant foreign body reaction. TCPM-covered silicone implants showed no apparent advantage in the reduction of capsular contracture. On the other hand, the indication for using this material as a supportive soft tissue structure can be confirmed.
Level of Evidence: not ratable, experimental study.
KeywordsBreast augmentation Capsular contracture Titanium coating Silicone implants Oncoplastic breast surgery
Conflict of interest
This study has been approved by the appropriate ethics committee and has therefore been performed in accordance with the ethical standards set forth in the 1964 Declaration of Helsinki and its later amendments.
The manuscript does not contain patient data.
- 4.Wixtrom RN, Stutman RL, Burke RM, Mahoney AK, Codner MA (2012) Risk of breast implant bacterial contamination from endogenous breast flora, prevention with nipple shields, and implications for biofilm formation. Aesthet Surg J 32(8):956–963Google Scholar
- 6.Jacombs A, Allan J, Hu H, Valente PM, Wessels WL, Deva AK, Vickery K (2012) Prevention of biofilm-induced capsular contracture with antibiotic-impregnated mesh in a porcine model. Aesthet Surg J 32(7):886–891Google Scholar
- 7.Marques M, Brown SA, Cordeiro ND, Rodrigues-Pereira P, Cobrado ML, Morales-Helguera A, Queiros L, Luis A, Freitas R, Goncalves-Rodrigues A, Amarante J (2011) Effects of coagulase-negative staphylococci and fibrin on breast capsule formation in a rabbit model. Aesthet Surg J 31(4):420–428Google Scholar
- 17.Strock LL (2009) Two stage expander implant reconstruction: recent experience breast reconstruction supplement. Plast Reconstr SurgGoogle Scholar
- 18.Heden P, Bronz G, Elberg JJ, Deraemaecker R, Murphy DK, Slicton A, Brenner RJ, Svarvar C, van Tetering J, van der Weij LP (2009) Long-term safety and effectiveness of style 410 highly cohesive silicone breast implants. Aesthetic Plast Surg 33(3):430–436, discussion 437–438PubMedCentralPubMedCrossRefGoogle Scholar
- 36.Scheidbach H, Tamme C, Tannapfel A, Lippert H, Kockerling F (2004) In vivo studies comparing the biocompatibility of various polypropylene meshes and their handling properties during endoscopic total extraperitoneal (TEP) patchplasty: an experimental study in pigs. Surg Endosc 18(2):211–220PubMedCrossRefGoogle Scholar