title: Noninvasive Shock Wave Treatment for Capsular Contractures After Breast Augmentation: A Rabbit Study.
abstract: BACKGROUND
  Capsular contracture is the most common complication of breast augmentation. Although numerous procedures are intended to prevent capsular contracture, their efficacy does not satisfy surgeons or patients. In the present study, we used shock waves to develop innovative protocols to treat capsular contracture in rabbits.
  
  
  METHODS
  We used shock waves to treat capsular contracture in a rabbit model. Six clinical parameters were evaluated to determine the treatment efficacy of shock waves on the pathological histology of capsular contracture. Dual-flip-angle T1-mapping magnetic resonance imaging was used to confirm the pathological findings.
  
  
  RESULTS
  Among the parameters, myxoid change, vascular proliferation, and lymphoplasma cell infiltration around the capsule increased more after treatment than they did in a control group. Capsular thickness, inner thinner collagen layer, and capsule wall collagen deposition decreased after shock wave treatment; only the inner thinner collagen layer and capsule wall collagen deposition changed significantly. The MRI findings for both scar thickness and water content were consistent with pathological biology findings.
  
  
  CONCLUSIONS
  This was the first pilot study and trial to treat capsular contractures using shock waves. We found that shock waves can cause changes in the structure or the composition of capsular contracture. We conclude that the treatment could decrease water content, loosen structure, decrease collagen deposition, and might alleviate scar formation from capsular contracture. We believe that the treatment could be a viable remedy for capsular contractures.
  
  
  METHODS
  This 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 .
authors.affiliation: Department of Biomedical Engineering, I-Shou University, Kaohsiung, Taiwan.
authors.forename: Po Chou
authors.initials: PC
authors.lastname: Chen
authors.affiliation: Department of Biomedical Engineering, I-Shou University, Kaohsiung, Taiwan.
authors.forename: Shyh Ming
authors.initials: SM
authors.lastname: Kuo
authors.affiliation: Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Jo Chi
authors.initials: JC
authors.lastname: Jao
authors.affiliation: Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Shiou Wen
authors.initials: SW
authors.lastname: Yang
authors.affiliation: Department of Surgery, Kaohsiung Armed Force General Hospital, Kaohsiung, Taiwan.
authors.forename: Ching Wen
authors.initials: CW
authors.lastname: Hsu
authors.affiliation: Department of Surgery, Kaohsiung Armed Force General Hospital, No.2, Zhongzheng 1st Rd., Lingya District, Kaohsiung, 80284, Taiwan. ranger.wu@mas.hinet.net.|National Kaohsiung University of Hospitality and Tourism, Kaohsiung, Taiwan. ranger.wu@mas.hinet.net.|Yuh-Ing Junior College of Health Care and Management, Kaohsiung, Taiwan. ranger.wu@mas.hinet.net.
authors.forename: Yu Chiuan
authors.initials: YC
authors.lastname: Wu
mesh_terms: D000818:Animals; D001707:Biopsy, Needle; D018427:Breast Implants / Q000009:adverse effects*; D004195:Disease Models, Animal; D005260:Female; D019220:High-Energy Shock Waves / Q000627:therapeutic use*; D007091:Image Processing, Computer-Assisted; D007150:Immunohistochemistry; D057910:Implant Capsular Contracture / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods; D008321:Mammary Glands, Animal; D010865:Pilot Projects; D011817:Rabbits; D011897:Random Allocation; D012016:Reference Values; D012680:Sensitivity and Specificity
keywords: Breast augmentation; Capsular contracture; Magnetic resonance imaging; Shock wave; T1-mapping technique