Tumour necrosis factor-α expression is associated with increased severity of periprosthetic breast capsular contracture.
BACKGROUND
The pathogenesis of periprosthetic capsular contracture following breast implant surgery is unclear. The aim of this study was to identify the expression of tumour necrosis factor-α (TNF-α), collagen type III α(1) (COL3A1), transforming growth factor-β(1) (TGF-β(1)) and connective tissue growth factor (CTGF) in different Baker grades of breast capsular contracture.


METHODS
Seven periprosthetic breast capsule specimens were collected from 6 patients. TNF-α, COL3A1, TGF-β(1) and CTGF gene expression were analysed using real-time quantitative polymerase chain reaction. Immunohistolocalisation of TNF-α was performed on paraffin-embedded sections. Significant correlations were analysed using the Pearson correlation coefficient.


RESULTS
TNF-α expression was associated with increased Baker grade of capsular contracture (Pearson correlation, r = 0.558; p = 0.02). COL3A1 gene expression was reduced with increasing severity of contracture (r = -0.490; p = 0.05). There were no significant correlations between TGF-β(1) and CTGF expression with Baker grade. Positive TNF-α staining in breast capsules was localised to fibroblasts, macrophages, and extracellularly close to the prosthesis.


CONCLUSIONS
The increased expression of TNF-α may play a key role in the inflammatory response associated with capsular contracture. The corresponding decrease in COL3A1 may contribute to the change in capsular physical properties seen in capsular contracture.
Plastic and Reconstructive Surgery Research, School of Translational Medicine, Manchester Interdisciplinary Biocentre, University of Manchester, Manchester, UK.
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Tan
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Wijeratne
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Shih
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Baildam
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Bayat
D000328:Adult; D001483:Base Sequence; D001940:Breast / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D018427:Breast Implants / Q000009:adverse effects*; D024061:Collagen Type III / Q000235:genetics; D055513:Connective Tissue Growth Factor / Q000235:genetics; D017931:DNA Primers / Q000235:genetics; D005260:Female; D015870:Gene Expression; D006801:Humans; D007150:Immunohistochemistry; D057910:Implant Capsular Contracture / Q000209:etiology* / Q000235:genetics* / Q000378:metabolism / Q000473:pathology; D008875:Middle Aged; D053773:Transforming Growth Factor beta1 / Q000235:genetics; D014409:Tumor Necrosis Factor-alpha / Q000235:genetics* / Q000378:metabolism
C526317:CCN2 protein, human; C439971:COL3A1 protein, human; D024061:Collagen Type III; D017931:DNA Primers; D053773:Transforming Growth Factor beta1; D014409:Tumor Necrosis Factor-alpha; D055513:Connective Tissue Growth Factor