Capsular contracture is the most frequent long-term complication after implant-based breast reconstruction or augmentation. The aim of this study was to evaluate the impact of implant surface properties on fibrotic capsule formation in an animal model. Twenty-four rats received 1 scaled down silicone implant each; 12 of the rats received implants with textured surfaces, and the other 12 received implants with smooth surfaces. After 60 and 120 days, rats in each group underwent 7-Tesla Magnetic Resonance Imaging (MRI) and high-resolution ultrasound (HR-US), and specimens of the capsules were acquired and used to measure capsule thickness through histology, collagen density through picro sirius red staining, and analyses of expression of pro-fibrotic and inflammatory genes (Collagen1-4, TGFb1, TGFb3, Smad3, IL4, IL10, IL13, CD68) through qRT-PCR. Furthermore, MRI data were processed to obtain capsule volume and implant surface area. On day 60, histology and HR-US showed that fibrotic capsules were significantly thicker in the textured implant group with respect to the smooth implant group (p<0.05). However, this difference did not persist on day 120 (p=0.56). Capsule thickness decreased significantly over the study period in both smooth and textured implant groups (p<0.05). Thickness measurements were substantiated by MRI analysis and volumes changed accordingly. Implant surface area did not vary between study dates, but it was different between implant types. On day 60, the density of collagen in the fibrotic capsules was significantly lower in the textured implant group with respect to the smooth group (p<0.05), but again this difference did not persist on day 120 (p=0.67). Collagen 1 and CD68 were respectively over- and under expressed in the textured implant group on day 60. Significant differences in the expression of other genes were not observed. Silicone implants with textured surfaces led to temporarily thicker but less dense fibrotic capsules compared with smooth surfaces. 7-Tesla MRI and HR-US are capable for non-invasive in-vivo assessment of capsular fibrosis in an animal model and can provide unique insights into the fibrotic process by 3D reconstruction and surface area measurement.

The Breast-Q questionnaire reduction module is an established tool for outcomes after reduction mammoplasty. This systematic review and meta-analysis assess key parameters affecting pre- and postoperative scores, with specific foci on patient characteristics and tissue resection weights. This study was conducted per PRISMA guidelines. PUBMED, Google Scholar, and Web of Science were searched. All studies published before August 1^st, 2021, were assessed for eligibility by two independent reviewers. Inclusion criteria were prospective or retrospective studies in six languages that reported quality of life after reduction mammoplasty using the Breast-Q questionnaire reduction module. Quality of included studies was assessed using the Newcastle-Ottawa-Scale. Analysis was performed per Cochrane Collaboration and the Quality of Reporting of Meta-analyses (QUOROM) guidelines. 28 papers were included in the systematic review, 13 for preoperative meta-analysis, and 17 for postoperative meta-analysis. Postoperative scores in all three quality of life domains (psychosocial, physical, and sexual wellbeing) and satisfaction with breasts increased significantly after reduction mammoplasty compared to preoperative scores. Satisfaction with breasts showed the greatest improvement, from 22.9 to 73.0. Preoperative scores were lower than normative data, with improvement to comparable scores as the healthy population postoperatively. Improvements in Breast-Q scores did not correlate with patient comorbidities, complication rates, or amount of breast tissue resected. Reduction mammoplasty provides marked improvement in Breast-Q patient-reported quality of life as well established in literature. However, these improvements do not correlate with tissue resection weights, warranting further inquiry of insurance-defined resection requirements.

: Oncoplastic breast surgery (OBS) arose to decrease the deformity following breast-conserving surgery (BCS) for breast cancer. In this meta-analysis (MA), we pool BREAST-Q questionnaire data to compare quality of life (QOL) in breast cancer patients who received BCS alone or in combination with level I or II oncoplastic breast surgery (BCS + OBS). All relevant databases were searched following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and QUOROM (Quality of Reporting of Meta-Analyses) guidelines. All prospective or retrospective studies with a BCS or BCS + OBS cohort that reported QOL as assessed with the BREAST-Q questionnaire were eligible. Fifty-five studies (75 distinct patient cohorts; 11,186 patients) were included in the MA, with 12 studies reporting both preoperative and postoperative values and eligible for a pair-wise MA. The pair-wise MA showed a significant postoperative improvement in the overall satisfaction with the breast (mean difference [MD] +8.0%, P = .003) and in the psychosocial well-being (MD +9.2%, 3.5-14.8, P = .001) of the entire cohort (BCS and BCS + OBS). A subgroup MA of proportions highlighted a superiority of BCS + OBS to BCS in overall satisfaction with the breast (72.0%, 68.0-76.1, vs 62.9%, 58.3-67.5; P = .02) and psychosocial well-being (78.9%, 71.5-86.4, vs 73.3%, 67.3-76.5, P = .0001). A leave-1-out sensitivity analysis confirmed the results of the pair-wise MA and the MA of proportions. Oncoplastic breast surgery effectively improves QOL and patient satisfaction based on the patient-reported outcomes assessed with the BREAST-Q questionnaire. The improvements were associated with acceptable complication rates, further supporting BCS followed by OBS when mastectomy would otherwise be necessary. Level of Evidence: 3: