Effects of Medical Chitosan on Capsular Formation Following Silicone Implant Insertion in a Rabbit Model.

[BACKGROUND] Capsular contracture is a serious complication that occurs after breast implant surgery. This study was performed to confirm that medical chitosan (MC) affects capsule formation and elucidates a possible mechanism.

[MATERIALS AND METHODS] In this study, we used 18 female adult New Zealand White rabbits. In each rabbit, two silicone implants were placed under the pectoralis muscle layer on both sides (one side was included in the experimental group and the other side was included in the control group). MC was applied around the silicone implant of the experiment group, while the control group received no treatment. The capsular thickness was calculated by Masson's trichrome stain. The expression of MMPs and TIMPs were determined by real-time PCR, Western blotting, and immunohistochemistry.

[RESULTS] Compared to the control group, the capsular thickness of the MC group was significantly reduced at 4, 8, and 12 weeks after the operation (4 week: 229.3 ± 72.2 vs 76.1 ± 12.6 µm, p < 0.05; 8 week: 326.0 ± 53.8 vs 155.4 ± 61.7 µm, p < 0.0.5; 12 week: 151.2 ± 52.5 vs 60.0 ± 22.0 µm, p < 0.05). Compared to the control group, the MC group had significantly lower expressions of TIMP-1 and TIMP-2 (p < 0.05). However, compared to the control group, there was no statistically significant difference in the expressions of MMP-2 and MMP-9 in the experiment group (p > 0.05).

[CONCLUSION] MC reduced the risk of developing capsular contracture around silicone implants, possibly by blocking the signaling pathway of TIMPs.

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