Two Independent Capsules Surrounding a Single Textured Implant in Ehlers-Danlos Syndrome
Summary:. Textured breast implants are associated with prolonged inflammation leading to increased risk for complications such as the development of anaplastic large cell lymphoma. The underlying molecular mechanisms that drive increased inflammation toward textured implants (compared with smooth im...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2022-08-01
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| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004470 |
| _version_ | 1811283139946872832 |
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| author | Jagannath Padmanabhan, PhD Farrah C. Liu, MD Dharshan Sivaraj, BS Dominic Henn, MD Kellen Chen, PhD Devorah R. Simon, BS Janos A. Barrera, MD Geoffrey C. Gurtner, MD, FACS |
| author_facet | Jagannath Padmanabhan, PhD Farrah C. Liu, MD Dharshan Sivaraj, BS Dominic Henn, MD Kellen Chen, PhD Devorah R. Simon, BS Janos A. Barrera, MD Geoffrey C. Gurtner, MD, FACS |
| author_sort | Jagannath Padmanabhan, PhD |
| collection | DOAJ |
| description | Summary:. Textured breast implants are associated with prolonged inflammation leading to increased risk for complications such as the development of anaplastic large cell lymphoma. The underlying molecular mechanisms that drive increased inflammation toward textured implants (compared with smooth implants) remain poorly understood. Here, we present the first known case of a patient with Ehlers-Danlos syndrome (EDS) who developed two independent fibrotic capsules around a single textured silicone implant. The patient was found to have one internal capsule tightly adherent to the implant and a second external capsule that was attached to the surrounding tissue. We observed that the internal implant-adherent capsule was composed of a highly aligned and dense collagen network, completely atypical for EDS and indicative of a high mechanical stress environment. In contrast, the external nonadherent capsule, which primarily interacted with the smooth surface of the internal capsule, displayed disorganized collagen fibers with no discernible alignment, classic for EDS. Remarkably, we found that the internal capsule displayed high activation of monocyte chemoattractant protein-1, a mechanoresponsive inflammatory mediator that was not elevated in the disorganized external capsule. Taken together, these findings demonstrate that the tight adhesion between the textured implant surface and the internal capsule creates a high mechanical stress environment, which is responsible for the increased local inflammation observed in the internal capsule. This unique case demonstrates that mechanical stress is able to override genetic defects locally in collagen organization and directly connects the textured surface of implants to prolonged inflammation. |
| first_indexed | 2024-04-13T02:05:10Z |
| format | Article |
| id | doaj.art-b4173ce7218c4a63847b985c3692cc53 |
| institution | Directory Open Access Journal |
| issn | 2169-7574 |
| language | English |
| last_indexed | 2024-04-13T02:05:10Z |
| publishDate | 2022-08-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj.art-b4173ce7218c4a63847b985c3692cc532022-12-22T03:07:29ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742022-08-01108e447010.1097/GOX.0000000000004470202208000-00040Two Independent Capsules Surrounding a Single Textured Implant in Ehlers-Danlos SyndromeJagannath Padmanabhan, PhD0Farrah C. Liu, MD1Dharshan Sivaraj, BS2Dominic Henn, MD3Kellen Chen, PhD4Devorah R. Simon, BS5Janos A. Barrera, MD6Geoffrey C. Gurtner, MD, FACS7From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Stanford, Calif.From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Stanford, Calif.From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Stanford, Calif.From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Stanford, Calif.From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Stanford, Calif.From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Stanford, Calif.From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Stanford, Calif.From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Stanford, Calif.Summary:. Textured breast implants are associated with prolonged inflammation leading to increased risk for complications such as the development of anaplastic large cell lymphoma. The underlying molecular mechanisms that drive increased inflammation toward textured implants (compared with smooth implants) remain poorly understood. Here, we present the first known case of a patient with Ehlers-Danlos syndrome (EDS) who developed two independent fibrotic capsules around a single textured silicone implant. The patient was found to have one internal capsule tightly adherent to the implant and a second external capsule that was attached to the surrounding tissue. We observed that the internal implant-adherent capsule was composed of a highly aligned and dense collagen network, completely atypical for EDS and indicative of a high mechanical stress environment. In contrast, the external nonadherent capsule, which primarily interacted with the smooth surface of the internal capsule, displayed disorganized collagen fibers with no discernible alignment, classic for EDS. Remarkably, we found that the internal capsule displayed high activation of monocyte chemoattractant protein-1, a mechanoresponsive inflammatory mediator that was not elevated in the disorganized external capsule. Taken together, these findings demonstrate that the tight adhesion between the textured implant surface and the internal capsule creates a high mechanical stress environment, which is responsible for the increased local inflammation observed in the internal capsule. This unique case demonstrates that mechanical stress is able to override genetic defects locally in collagen organization and directly connects the textured surface of implants to prolonged inflammation.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004470 |
| spellingShingle | Jagannath Padmanabhan, PhD Farrah C. Liu, MD Dharshan Sivaraj, BS Dominic Henn, MD Kellen Chen, PhD Devorah R. Simon, BS Janos A. Barrera, MD Geoffrey C. Gurtner, MD, FACS Two Independent Capsules Surrounding a Single Textured Implant in Ehlers-Danlos Syndrome Plastic and Reconstructive Surgery, Global Open |
| title | Two Independent Capsules Surrounding a Single Textured Implant in Ehlers-Danlos Syndrome |
| title_full | Two Independent Capsules Surrounding a Single Textured Implant in Ehlers-Danlos Syndrome |
| title_fullStr | Two Independent Capsules Surrounding a Single Textured Implant in Ehlers-Danlos Syndrome |
| title_full_unstemmed | Two Independent Capsules Surrounding a Single Textured Implant in Ehlers-Danlos Syndrome |
| title_short | Two Independent Capsules Surrounding a Single Textured Implant in Ehlers-Danlos Syndrome |
| title_sort | two independent capsules surrounding a single textured implant in ehlers danlos syndrome |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004470 |
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