Capsular contracture is the Achilles heel of breast augmentation with implants. A thickened capsule can lead to implants feeling firm, looking bad, and sitting in the wrong position. The two major theories for why this happens currently are biofilm (a low grade colonization of bacteria) or an exuberant inflammatory response by the body.
This is a study out of Boston, where they used tissue expanders, stimulated them to form capsular contracture, and then treated the capsular contracture with “Photochemical Tissue Passivation.” (Yes, I am with you. What is that?!@!)
“Prevention of Capsular Contracture with Photochemical Tissue Passivation” appeared in our March 2014 Plastic and Reconstructive Surgery Journal. What they did:
- Tissue expanders placed under the muscle of rabbits
- Injection of fibrin glue to induce contracture
- Treated pockets were coated with photosensitizing dye and then exposed to 532 nm light
- After 8 weeks the capsules were harvested and analyzed.
What did they find?
52% decrease in capsule thickness compared to controls
- Less fibrohistiocytic cells, macrophages
- Decreased synovial metaplasia
- Less smooth muscle actin deposition. (it resembled controls which did not have any fibrin glue)
So?
They discuss capsular contracture. They state capsular contracture is likely multifactorial. “What is certain is there is a robust inflammatory response.” The authors favor an inflammatory reaction to a foreign body (more than they favor biofilm) as an explanation for capsular contracture.
They argue the foreign body theory is supported by differences in capsular contracture seen in different implant composition and texture. They think the light treatment causes collagen to cross link tightly, forming an impenetrable layer between your body and the foreign object. They imagine it is like a wall separating the two, so the foreign object doesn’t irritate your body. Less irritation = less capsular contracture/thickness. They also think the light treatment helps prevent formation of pathologic collagen bundles which are prone to contracting.
I don’t know I agree totally with everything. I wonder if the light treatment is like using light to disinfect surfaces, and if this is still somehow related to biofilm too. This is my first exposure to this technique, and I would need to investigate it more.
Regardless, I am always on the lookout for anything to lower our risk of capsular contracture.
A simple light treatment to reduce risk? I look forward to hearing more. as they develop this idea further.