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



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.


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.


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).


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.

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Capsule formation Dexamethasone Implant Toll-like receptor 



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.


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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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