Abstract
IntroductionThe etiology of capsular contracture after surgical implantation of breast implants remains unclear, but an important role is seen for the immune system. Toll-like receptors are immune receptors recognizing both pathogen-associated molecular patterns and damage-associated molecular patterns. The former are present on bacteria such as Staphylococcus epidermidis (bacteria earlier associated with capsular contracture), and the latter are released after (mechanical) stress. The aim of this study was to investigate the expression of TLRs 1–10 in relation to capsular contracture.Materials and MethodsFifty consecutive breast capsules were collected during implant removal or replacement. The extent of capsular contracture was scored according to the Baker score. A sample specimen (0.5 cm3) was obtained from all tissues. cDNA was synthesized from isolated mRNA from the collected specimens. PCR analyses were conducted to test for cDNA presence and to quantify concentration. TLR1–10 expression was measured for each of the Baker scores separately and compared to all Baker scores.ResultsExpression of all TLRs in all Baker scores was seen. TLR2 and TLR6 were more often present in contracted samples (Baker 3 or 4) compared to uncontracted samples (Baker 1 or 2) [Baker 2 vs. 3 (p = 0.034) and Baker 2 vs. 3 (p = 0.003), respectively]. None of the TLRs displayed a significantly higher expression in contracted capsules compared to uncontracted capsules.ConclusionThis study shows that TLR2 and TLR6 are more often expressed in contracted capsules compared to non-contracted capsules however not in higher concentrations.Level of Evidence IIIThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Highlights
The etiology of capsular contracture after surgical implantation of breast implants remains unclear, but an important role is seen for the immune system
Tolllike receptors are immune receptors recognizing both pathogen-associated molecular patterns and damage-associated molecular patterns. The former are present on bacteria such as Staphylococcus epidermidis, and the latter are released after stress
This study shows that TLR2 and TLR6 are more often expressed in contracted capsules compared to non-contracted capsules not in higher concentrations
Summary
The etiology of capsular contracture after surgical implantation of breast implants remains unclear, but an important role is seen for the immune system. Tolllike receptors are immune receptors recognizing both pathogen-associated molecular patterns and damage-associated molecular patterns The former are present on bacteria such as Staphylococcus epidermidis (bacteria earlier associated with capsular contracture), and the latter are released after (mechanical) stress. CDNA was synthesized from isolated mRNA from the collected specimens. TLR1–10 expression was measured for each of the Baker scores separately and compared to all Baker scores. Capsule formation is a normal foreign body reaction occurring around all implants [17, 34]. In selected cases this capsule formation around breast implants tends to progress, leading to capsular contracture. This complication presents with signs of hardening and disfiguring of the breast and is often painful [16]. The Baker score is used to clinically score the severity of capsular contracture, where Baker scores 1 and 2 represent normal
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