Silicone implants are frequently used for breast augmentation and reconstruction. However, late complication, such as capsular contracture, remain the most important side effect. In this study we compare different methods for reducing the inflammatory reaction around the silicone implant by introducing one microtextured breast implant in wistar rats. The rats were dividing in 4 groups: the first one was the control group that received untreated implant; in the second we used silicone implants impregnated with rifampin solution, the third one had implant combined with intramuscular dexamethasone injection and the last one had silicone implant associated with autologous centrifuged fat introduced in the implant pocket. The implants and the capsular tissue surrounding were removed after eight weeks. Capsule samples were submitted to histological evaluations. The present study demonstrated that fat grafting may have a role in reducing and preventing capsular contractures after breast augmentation with silicone implants by decreasing the inflammatory process.

Background: Capsular contracture remains a common complication in silicone breast implantation. The etiology, formation mechanisms, predisposing and favoring factors are still subjects of research. This study aims to demonstrate the effectiveness of using autologous fat introduced periprosthetically in preventing capsular contracture compared to other known methods: antibiotics and corticosteroids. Methods: A cohort of 80 Wistar rats was included in the study, divided into four subgroups. All subjects received a silicone implant, implanted in a pocket created along the abdominal midline. The first subgroup served as the control group, with subjects having the implant placed without any treatment. For the second and third subgroups, the implants were treated with an antibiotic solution and intramuscular injections of dexamethasone, respectively. The subjects in the last subgroup received centrifuged autologous fat introduced periprosthetically. Results: The subgroup with autologous fat exhibited a significantly smaller capsule thickness, which was poorly represented, with a smooth surface. The use of autologous fat for treating silicone prosthesis was linked with the lack of acute inflammation around the prosthetic site. Conclusions: Autologous fat helps to minimize the “non-self” reaction, which results in the development of a periprosthetic capsule consisting of mature collagen fibers interspersed with adipocytes.

Breast augmentation with silicone implants is one of the most common procedures performed by plastic surgeons around the world. Capsular contracture is one of the complication in breast augmentation that requires invasive reparation surgery. The inflammatory response to the breast implants appears to be directly associated with capsular contracture. In addition to the type of material (saline vs. silicone) used and it’s texture (smooth vs. textured), a number of factors were detected related to their position and the existence of a history of radiotherapy after cancer treatment for breast cancer. It tries to identify ideal methods to prevent and minimize the risk of developing capsular contracture. Among the methods currently used were described: placement of the implant in the retropectoral plane, dissection of a larger pocket, performing a rigorous hemostasis, use of implants with textured surface, minimizing the exposure time, contact and handling of the implant, irrigation of the pocket with antiseptic solutions (5% betadine) or broad-spectrum antibiotic solution to prevent the infectious process, the use of talc-free gloves, the use of corticosteroids, immuno-modulators and anti-inflammatory drugs.

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