Magill, Louise Jane; (2018) Investigating mechanisms of breast implant failure and the role of radiotherapy. Doctoral thesis (M.D(Res)), UCL (University College London).

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Abstract

Breast implants have a role in both aesthetic and reconstructive surgery. They are however, associated with long-term complications including capsular contracture (a fibrotic encapsulation of the implant), implant rupture and leakage often necessitating further corrective surgery. The mechanisms driving these complications are not fully understood. Indications for post mastectomy radiation therapy are expanding leading to more patients with implant based breast reconstructions receiving it. The aim of this thesis was to investigate failure mechanisms of breast implants and the role of radiation therapy in its pathogenesis. Meta-analysis was performed investigating the clinical outcomes of PMRT directly upon the permanent implant in patients undergoing breast reconstruction. Retrieved breast implants and the corresponding capsular tissue from patients were collected and their material characteristics and histology studied. Un-implanted (control) Silicone breast implant shells were submitted to treatment dose radiation therapy and their material characteristics evaluated and compared to those of casted PCU and POSS-PCU. Meta-analysis demonstrated increased surgical complication rates and poorer patient satisfaction and cosmetic outcome in the PMRT group. Retrieved breast implants demonstrated a significant reduction in mechanical strength properties with increasing duration of implantation but there was no correlation with thickness of the corresponding retrieved fibrotic capsule. Treatment dose radiation to un-implanted silicone breast implant shells had no overall significant effect on its material characteristics or in vitro cellular response. This was in keeping with the response to PMRT of PCU and POSS-PCU, however POSS-PCU demonstrated different mechanical properties in comparison to silicone. These results indicate that although radiation therapy is significantly associated with poorer clinical outcomes for patients with implant based reconstruction, it is not due to alterations in the mechanical strength and surface chemical properties of the silicone implant shells. Therefore further study evaluating the tissue response to the implant in the setting of radiation therapy is required.

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