Characterization of the Capsule Surrounding Smooth and Textured Tissue Expanders and Correlation with Contracture

Erika Kuriyama, Hiroko Ochiai, Yoshikazu Inoue, Yoshiaki Sakamoto, Naoki Yamamoto, Toshiaki Utsumi, Kazuo Kishi, Takayuki Okumoto, Akihiro Matsuura

Research output: Contribution to journalArticlepeer-review

18 Citations (Scopus)


Background: Capsular contracture is a common complication after breast augmentation surgery. This study pathologically evaluated the soft-tissue response to surface modifications in both smooth and textured tissue expander prostheses. Methods: Smooth tissue expanders and textured tissue expanders in 5 cases each were used for breast reconstruction after mastectomy. Histological samples were harvested from the capsules when the tissue expanders were replaced by silicone implants. Collagen orientation and cellular responses were assessed histologically. Capsular contracture was evaluated using the Baker classification 6 months and 2 years after the removal of the tissue expander. Results: The capsules surrounding the smooth tissue expanders tended to produce more contracture than those surrounding the textured tissue expanders. The collagen architecture of the capsules of the smooth tissue expanders showed random orientation with fragmentation. Conversely, the capsules of the textured tissue expanders showed parallel orientation with collagen bundles of almost normal structure. Significantly more fibrils of elastin and myofibroblasts were found in the capsules surrounding the smooth tissue than in those surrounding the textured ones. Conclusions: The collagen fibers surrounding the smooth tissue expanders could be cracked during expansion, which may lead to scarring and contracture. Conversely, the collagen orientation surrounding the textured tissue expanders was excellent. Moreover, the increase in elastic fibers and myofibroblasts in the capsules surrounding the smooth tissue expanders may be associated with in vivo contraction patterns. Therefore, the surface type of tissue expanders affects capsular contraction after replacement with definitive implants.

Original languageEnglish
Article numbere1403
JournalPlastic and Reconstructive Surgery - Global Open
Issue number7
Publication statusPublished - 2017 Jul 1

ASJC Scopus subject areas

  • Surgery


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