Der Einfluss von Matrix-Metalloproteinasen und ihrer Inhibitoren auf die Kapselbildung nach Mammaaugmentation mit texturierten und glattwandigen Silikongel-Implantaten
The pathophysiology of a capsular contracture after alloplastic breast augmentation resembles that of other fibrotic diseases. In this regard, the matrix metalloproteinases (MMPs) and their inhibitors, the tissue inhibitors of matrix metalloproteinases (TIMPs), play an important role. In my study, the relative expression of MMP-2,-9, TIMP-1 and-2 were determined in the capsular tissue of patients with capsular contracture after breast augmentation with silicone gel implants. The study included 20 female patients (average age 37 ± 15 years) with capsular contracture after bilateral subpectoral cosmetic breast augmentation with smooth silicone gel implants. Ten patients developed grade II capsule contracture according to the classification described by Baker. Eight women had grade III contracture, and one woman had grade IV contracture. 20 other female patients (average age 41 ± 9 years) with capsular contracture after bilateral cosmetic breast augmentation with textured silicone gel implants were also included in the study. Ten patients developed grade II capsule contracture. Eight women had grade III contracture, and two women had grade IV contracture. The examination was based on a real-time RT-PCR methodology. The relative expression of MMP-2 was significantly higher in capsular tissue of patients with textured silicone gel implants and capsular contracture grades II and III/ IV compared with that in capsular tissue from patients with grade I capsular contracture (p<0.05). Patients with smooth gel implants and capsular contracture grades II and III/ IV showed no significant difference in the relative expression of MMP-2 in their capsular tissue compared with patients with a grade I fibrosis. Patients with smooth and textured silicone gel implants and capsular contracture grades II and III/ IV presented no significant difference in expression of MMP-9 in capsular tissue in comparison to patients with capsular contracture grade I. There was no significant difference in the relative expression of MMP-9 in capsular tissue from patients with smooth silicone gel implants compared with tissue from patients with textured silicone gel implants. The relative expressions of TIMP-1 and TIMP-2 were significantly higher in the capsular tissue of patients with severe contracture in comparison to tissue from patients with capsular contracture grade I (p<0.05). Compared with capsular tissue from patients with grades III/ IV and textured implants, the capsular tissue from patients with smooth silicone gel implants showed a significant increase for TIMP-1 and TIMP-2 (p<0.05). The female patients with capsular contracture, who were examined in this study, showed that the physiological balance between MMPs and their inhibitors was disturbed. The disturbance in the systemic MMP-to-TIMP ratio can cause increased synthesis and deposition of collagen, leading to capsular contracture.
info:eu-repo/classification/ddc/610, Mammaaugmentation, Implantat, Prothese, Medizin, Brustvergrößerung, Kapselfibrose, Kapselbildung, Komplikation, Hülle, breast augmentation, capsular contracture, capsular formation
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