The Effect of Anti-Adhesive Agent on Capsular Formation of Breast Implant in Rabbit

Goals/Purpose: Capsular contracture is the most troublesome complication after breast aesthetic surgery. Capsule can be seen as a normal foreign body reaction, when implant is inserted into the body. But, pathologic capsular contracture can induce severe symptoms such as pain, tenderness, and breast distortion. This study was performed to examine the effect of anti-adhesive agent on capsular formation of breast implant in rabbits.

Methods/Technique: Twelve smooth-surfaced cohesive-gel implants were implanted to twelve Newzealand white rabbits weighting 1.8kg ~ 2.6kg. These 5 x 5 x 1 cm sized miniature implants were designed to be identical to currently used products for breast augmentation. After skin incision, exposed latissimus dorsi muscle was elevated and submuscular pocket was made. The rabbits were divided into two groups. In experimental group (n=6), implant and 2cc of anti-adhesion agent (Guardix®, Hanmi Medical Co., Korea) were inserted to the pocket under muscle. In control group (n=6), implants and 2cc of saline were inserted to the pocket. Running the follow up period of two months, the rabbits were imaged monthly by 3 dimensional CT(computed tomography) for capsule formation follow-up changes. Two months later, the animals were euthanized and implant with peri-implant capsule were excised totally. And then, we evaluated capsule thickness(hematoxylin and eosin stain), collagen pattern(masson trichrome stain), and myofibroblast count(α-smooth muscle actin stain) in lateral, ventral, and dorsal aspects.

Results/Complications: Grossly, the capsules of experimental group were relatively more transparent than those of control group. But, no significant differences of capsule thickness and capsular contracture were watched on 3D CT finding. In histologic evaluation, the thickness of capsule was measured more thin in all aspects(Table I), the pattern of collagen was the higher parallel alignment with low density, and the count of myofibroblast was fewer in experimental group than in control group(Table II).

Conclusion: We suggest that anti-adhesion agent can be helpful in reducing capsular formation. Later, clinical trials will be needed.

Table. 1. Characteristics of Capsule thickness in Anti-adhesion agent and Normal saline Groups

	Control (n=6)	Experimental (n=6)	p-value
Ventral aspect of capsule thickness	0.078 ± 0.041	0.032 ± 0.013	0.027*
Lateral aspect of capsule thickness	0.097 ± 0.050	0.040 ± 0.014	0.027*
Dorsal aspect of capsule thickness	0.110 ± 0.054	0.050 ± 0.017	0.028*

Table. 2. Characteristics of the myofibroblast ratio in Anti-adhesion agent and Normal saline Groups

	Control (n=6)	Experimental (n=6)	p-value
Ventral aspect of myofibroblast ratio	1.333 ± 0.516	0.167 ± 0.408	0.009*
Lateral aspect of myofibroblast ratio	2.000 ± 0.000	0.833 ± 0.408	0.002*
Dorsal aspect of myofibroblast ratio	2.833 ± 0.408	1.333 ± 0.516	0.004*