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Aesthetic Plastic Surgery

, Volume 42, Issue 4, pp 1133–1143 | Cite as

Evaluation of Safe Systemic Immunosuppression Created with Dexamethasone in Prevention of Capsular Contracture: A Glance to Distinct Perspectives with Toll-Like Receptors

  • Ozlem Colak
  • Kadri Ozer
  • Adile Dikmen
  • Hilal Ozakinci
  • Ozay Ozkaya
Original Article Basic Science/Experimental

Abstract

Purpose

The toll-like receptors (TLRs) stand at the interface of innate immune activation. We hypothesize to decrease the response of innate immunity activated by TLR4 by a safe, short-term, systemic immunosuppression.

Methods

Two silicone block implants were placed into two dorsal subcutaneous pockets in 32 rats that were subdivided into four groups: The two study groups were the IV DEX group (single intravenous injection of dexamethasone 1 h before surgery) and the IV DEX + IP DEX group (in addition to a single intravenous injection of dexamethasone 1 h before surgery, intraperitoneal dexamethasone was administered for 10 days after surgery), and the two control groups were the untreated control group and the saline-treated control group. After 10 weeks, all animals were killed to determine capsular thickness, inflammatory cell density, presence of pseudoepitheliomatous hyperplasia, edema, necrosis, vascularization, TLR4 expression and myofibroblast proliferation.

Results

No significant difference was observed in any parameter between the untreated and saline-treated control groups (p > 0.05). Capsular thickness, myofibroblast proliferation, TLR4 expression density were statistically different among study groups compared to control (p < 0.05).

Conclusions

This study demonstrates the relationship between toll-like receptors and fibrous capsule after implant surgery. Decreasing the innate immunity by a safe, short-term perioperative systemic immunosuppression resulted in decreased TLR4 expression and myofibroblast differentiation which could be a new research field in profibrotic pathophysiology underlying breast capsule formation.

No Level Assigned

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Keywords

Capsule formation Dexamethasone Implant Toll-like receptor 

Notes

Acknowledgements

All authors (OC, KO, AD, HO, OO) confirmed no funding supporting the work and no statement of financial interest and no conflict of interest. All authors bear the responsibility of this letter.

References

  1. 1.
    American Society of Plastic Surgeons (2016) ASPS national clearinghouse of plastic surgery procedural statistics. https://www.plasticsurgery.org/documents/News/Statistics/2016/plastic-surgery-statistics-full-report-2016.pdf
  2. 2.
    Berry MG, Cucchiara V, Davies DM (2010) Breast augmentation: part II—Adverse capsular contracture. J Plast Reconstr Aesthet Surg 63:2098–2107.  https://doi.org/10.1016/j.bjps.2010.04.011 CrossRefPubMedGoogle Scholar
  3. 3.
    Persichetti P, Segreto F, Carotti S et al (2014) Oestrogen receptor-alpha and -beta expression in breast implant capsules: experimental findings and clinical correlates. J Plast Reconstr Aesthet Surg 67:308–315.  https://doi.org/10.1016/j.bjps.2013.12.002 CrossRefPubMedGoogle Scholar
  4. 4.
    Hwang K, Sim HB, Huan F, Kim DJ (2010) Myofibroblasts and capsular tissue tension in breast capsular contracture. Aesthet Plast Surg 34:716–721.  https://doi.org/10.1007/s00266-010-9532-8 CrossRefGoogle Scholar
  5. 5.
    Steiert AE, Boyce M, Sorg H (2013) Capsular contracture by silicone breast implants: possible causes, biocompatibility, and prophylactic strategies. Med Devices Evid Res 6:211–218.  https://doi.org/10.2147/MDER.S49522 CrossRefGoogle Scholar
  6. 6.
    Segreto F, Carotti S, Tosi D et al (2016) Toll-like receptor 4 expression in human breast implant capsules: localization and correlation with estrogen receptors. Plast Reconstr Surg 137:792–798.  https://doi.org/10.1097/01.prs.0000479941.42174.f1 CrossRefPubMedGoogle Scholar
  7. 7.
    Mollen KP, Anand RJ, Tsung A et al (2006) Emerging paradigm: toll-like receptor 4-sentinel for the detection of tissue damage. Shock 26:430–437.  https://doi.org/10.1097/01.shk.0000228797.41044.08 CrossRefPubMedGoogle Scholar
  8. 8.
    Wang J, Hori K, Ding J et al (2011) Toll-like receptors expressed by dermal fibroblasts contribute to hypertrophic scarring. J Cell Physiol 226:1265–1273.  https://doi.org/10.1002/jcp.22454 CrossRefPubMedGoogle Scholar
  9. 9.
    Chen J, Zeng B, Yao H, Xu J (2013) The effect of TLR4/7 on the TGF-β-induced Smad signal transduction pathway in human keloid. Burns 39:465–472.  https://doi.org/10.1016/j.burns.2012.07.019 CrossRefPubMedGoogle Scholar
  10. 10.
    Goldberg EP (1997) Silicone breast implant safety: physical, chemical, and biologic problems. Plast Reconstr Surg 99:258–261CrossRefPubMedGoogle Scholar
  11. 11.
    Kumar VH, Im NN, Huilgol SV et al (2015) Dose dependent hepatic and endothelial changes in rats treated with dexamethasone. J Clin Diagn Res 9:FF08-10.  https://doi.org/10.7860/jcdr/2015/12810.5930 PubMedCrossRefGoogle Scholar
  12. 12.
    Schmelzer TM, Heath JJ, Hope WW et al (2008) The effect of preoperative corticosteroids on peritoneal macrophage function after laparoscopic and open abdominal surgery in a rat model. Am J Surg 196:920-4-5.  https://doi.org/10.1016/j.amjsurg.2008.07.023 CrossRefGoogle Scholar
  13. 13.
    Chen D, Yang MR, Huang LN et al (2014) Dexamethasone-induced hyposensitivity to rocuronium in rat diaphragm associated with muscle-fiber transformation. Mol Med Rep 9:527–534.  https://doi.org/10.3892/mmr.2013.1819 CrossRefPubMedGoogle Scholar
  14. 14.
    Rehg JE, Hancock ML, Woodmansee DB (1988) Characterization of a dexamethasone-treated rat model of cryptosporidial infection. J Infect Dis 158:1406–1407CrossRefPubMedGoogle Scholar
  15. 15.
    Marques M, Brown S, Correia-Sá I et al (2012) The impact of triamcinolone acetonide in early breast capsule formation in a Rabbit Model. Aesthet Plast Surg 36:986–994.  https://doi.org/10.1007/s00266-012-9888-z CrossRefGoogle Scholar
  16. 16.
    Prantl L, Schreml S, Fichtner-Feigl S et al (2007) Clinical and morphological conditions in capsular contracture formed around silicone breast implants. Plast Reconstr Surg 120:275–284.  https://doi.org/10.1097/01.prs.0000264398.85652.9a CrossRefPubMedGoogle Scholar
  17. 17.
    Ojo-Amaize EA, Conte V, Lin HC et al (1994) Silicone-specific blood lymphocyte response in women with silicone breast implants. Clin Diagn Lab Immunol 1:689–695PubMedPubMedCentralGoogle Scholar
  18. 18.
    Smalley DL, Shanklin DR, Hall MF et al (1995) Immunologic stimulation of T lymphocytes by silica after use of silicone mammary implants. FASEB J 9:424–427CrossRefPubMedGoogle Scholar
  19. 19.
    Wolfram D, Dolores W, Rainer C et al (2004) Cellular and molecular composition of fibrous capsules formed around silicone breast implants with special focus on local immune reactions. J Autoimmun 23:81–91.  https://doi.org/10.1016/j.jaut.2004.03.005 CrossRefPubMedGoogle Scholar
  20. 20.
    Portou MJ, Baker D, Abraham D, Tsui J (2015) The innate immune system, toll-like receptors and dermal wound healing: a review. Vascu Pharmacol 71:31–36.  https://doi.org/10.1016/j.vph.2015.02.007 CrossRefGoogle Scholar
  21. 21.
    Huebener P, Schwabe RF (2013) Regulation of wound healing and organ fibrosis by toll-like receptors. Biochim Biophys Acta 1832:1005–1017.  https://doi.org/10.1016/j.bbadis.2012.11.017 CrossRefPubMedGoogle Scholar
  22. 22.
    Chen L, Guo S, Ranzer MJ, DiPietro LA (2013) Toll-like receptor 4 has an essential role in early skin wound healing. J Invest Dermatol 133:258–267.  https://doi.org/10.1038/jid.2012.267 CrossRefPubMedGoogle Scholar
  23. 23.
    Isom C, Kapoor V, Wilson L et al (2007) Breast implant capsules are partially composed of bone marrow-derived cells. Ann Plast Surg 58:377–380.  https://doi.org/10.1097/01.sap.0000243996.37786.4a CrossRefPubMedGoogle Scholar
  24. 24.
    Dancey A, Nassimizadeh A, Levick P (2012) Capsular contracture—what are the risk factors? a 14 year series of 1400 consecutive augmentations. J Plast Reconstr Aesthet Surg 65:213–218CrossRefPubMedGoogle Scholar
  25. 25.
    Çolak Ö, Ozer K, Dikmen A (2016) Toll-like receptor 4 expression in human breast implant capsules: localization and correlation with estrogen receptors. Plast Reconstr Surg 138:757e–758e.  https://doi.org/10.1097/PRS.0000000000002570 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2018

Authors and Affiliations

  1. 1.Istanbul Okmeydani Training and Research Hospital, Plastic, Reconstructive and Aesthetic Surgery ClinicIstanbulTurkey
  2. 2.Aydin State Hospital, Plastic, Reconstructive and Aesthetic Surgery ClinicAydınTurkey
  3. 3.Sinop Ataturk State Hospital, Plastic, Reconstructive and Aesthetic Surgery ClinicSinopTurkey
  4. 4.Department of PathologyAnkara 29 Mayis State HospitalAnkaraTurkey

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