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The surface topography of silicone breast implants mediates the foreign body response in mice, rabbits and humans

Nature Biomedical Engineering volume 5, pages 1115–1130 (2021)Cite this article

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Abstract

Silicone is widely used in chronic implants and is generally perceived to be safe. However, textured breast implants have been associated with immune-related complications, including malignancies. Here, by examining for up to one year the foreign body response and capsular fibrosis triggered by miniaturized or full-scale clinically approved breast implants with different surface topography (average roughness, 0–90 μm) placed in the mammary fat pads of mice or rabbits, respectively, we show that surface topography mediates immune responses to the implants. We also show that the surface surrounding human breast implants collected during revision surgeries also differentially alters the individual’s immune responses to the implant. Moreover, miniaturized implants with an average roughness of 4 μm can largely suppress the foreign body response and fibrosis (but not in T-cell-deficient mice), and that tissue surrounding these implants displayed higher levels of immunosuppressive FOXP3+ regulatory T cells. Our findings suggest that, amongst the topographies investigated, implants with an average roughness of 4 μm provoke the least amount of inflammation and foreign body response.

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Fig. 1: Roughness and chemical composition of human-scale implants versus miniaturized implant mimics.
Fig. 2: Breast implant surface topography affects host response and fibrosis in rabbits.
Fig. 3: Breast implant surface topography affects host responses and fibrosis in mice.
Fig. 4: Acute immune effects two weeks after implantation revealed by scRNA-seq.
Fig. 5: Long-term kinetics of host immune response to 0 and 4 μm implants in wild-type mice, and testing in nude mice implicating a T-cell-regulated mechanism.
Fig. 6: Human breast tissue explant histology and immune profiling.

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Data availability

The main data supporting the findings of this study are available within the paper and its Supplementary Information. The raw and analysed datasets generated during the study are available for research purposes from the corresponding authors on reasonable request. High-throughput sequencing data have been deposited in the Gene Expression Omnibus (GEO) database, with series accession number GSE164645.

References

  1. Teo, A. J. T. et al. Polymeric biomaterials for medical implants and devices. ACS Biomater. Sci. Eng. 2, 454–472 (2016).

    Article  CAS  PubMed  Google Scholar 

  2. Lloyd, A. W., Faragher, R. G. & Denyer, S. P. Ocular biomaterials and implants. Biomaterials 22, 769–785 (2001).

    Article  CAS  PubMed  Google Scholar 

  3. McLaughlin, K., Jones, B., Mactier, R. & Porteus, C. Long-term vascular access for hemodialysis using silicon dual-lumen catheters with guidewire replacement of catheters for technique salvage. Am. J. Kidney Dis. 29, 553–559 (1997).

    Article  CAS  PubMed  Google Scholar 

  4. Khoo, C. T. Silicone synovitis. The current role of silicone elastomer implants in joint reconstruction. J. Hand Surg. Br. 18, 679–686 (1993).

    Article  CAS  PubMed  Google Scholar 

  5. VandeVord, P. J. et al. Immune reactions associated with silicone-based ventriculo-peritoneal shunt malfunctions in children. Biomaterials 25, 3853–3860 (2004).

    Article  CAS  PubMed  Google Scholar 

  6. Gabriel, A. & Maxwell, G. P. The evolution of breast implants. Clin. Plast. Surg. 42, 399–404 (2015).

    Article  PubMed  Google Scholar 

  7. Yoda, R. Elastomers for biomedical applications. J. Biomater. Sci. Polym. Ed. 9, 561–626 (1998).

    Article  CAS  PubMed  Google Scholar 

  8. Hanak, B. W., Bonow, R. H., Harris, C. A. & Browd, S. R. Cerebrospinal fluid shunting complications in children. Pediatr. Neurosurg. 52, 381–400 (2017).

    Article  PubMed  Google Scholar 

  9. O’Malley, J. T., Burgess, B. J., Galler, D. & Nadol, J. B. Jr. Foreign body response to silicone in cochlear implant electrodes in the human. Otol. Neurotol. 38, 970–977 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  10. Coroneos, C. J. et al. US FDA breast implant postapproval studies: long-term outcomes in 99,993 patients. Ann. Surg. 269, 30–36 (2019).

    Article  PubMed  Google Scholar 

  11. Headon, H., Kasem, A. & Mokbel, K. Capsular contracture after breast augmentation: an update for clinical practice. Arch. Plast. Surg. 42, 532–543 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  12. Castel, N., Soon-Sutton, T., Deptula, P., Flaherty, A. & Parsa, F. D. Polyurethane-coated breast implants revisited: a 30-year follow-up. Arch. Plast. Surg. 42, 186–193 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  13. Xu, H. et al. Hydrogel-coated ventricular catheters for high-risk patients receiving ventricular peritoneum shunt. Medicine 95, e4252 (2016).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Barnea, Y., Hammond, D. C., Geffen, Y., Navon-Venezia, S. & Goldberg, K. Plasma activation of a breast implant shell in conjunction with antibacterial irrigants enhances antibacterial activity. Aesthet. Surg. J. 38, 1188–1196 (2018).

    Article  PubMed  Google Scholar 

  15. Stevens, W. G. et al. Risk factor analysis for capsular contracture: a 5-year Sientra study analysis using round, smooth, and textured implants for breast augmentation. Plast. Reconstr. Surg. 132, 1115–1123 (2013).

    Article  CAS  PubMed  Google Scholar 

  16. Mempin, M., Hu, H., Chowdhury, D., Deva, A. & Vickery, K. The A, B and C’s of silicone breast implants: anaplastic large cell lymphoma, biofilm and capsular contracture. Materials 11, 2393 (2018).

    Article  CAS  PubMed Central  Google Scholar 

  17. Mendonça, A. M., Santanelli di Pompeo, F. & De Mezerville, R. Nanotechnology, nanosurfaces and silicone gel breast implants: current aspects. Case Rep. Plast. Surg. Hand Surg. 4, 99–113 (2017).

    Article  Google Scholar 

  18. Munhoz, A. M., Clemens, M. W. & Nahabedian, M. Y. Breast implant surfaces and their impact on current practices: where we are now and where are we going. Plast. Reconstr. Surg. Global Open 7, e2466 (2019).

    Article  Google Scholar 

  19. Technical Committee ISO/TC 150. ISO 14607 Non-Active Surgical Implants—Mammary Implants—Particular Requirements 3rd edn (ISO copyright office, 2018).

  20. Barnsley, G. P., Sigurdson, L. J. & Barnsley, S. E. Textured surface breast implants in the prevention of capsular contracture among breast augmentation patients: a meta-analysis of randomized controlled trials. Plast. Reconstr. Surg. 117, 2182–2190 (2006).

    Article  CAS  PubMed  Google Scholar 

  21. Derby, B. M. & Codner, M. A. Textured silicone breast implant use in primary augmentation: core data update and review. Plast. Reconstr. Surg. 135, 113–124 (2015).

    Article  CAS  PubMed  Google Scholar 

  22. Tevis, S. E. et al. Breast implant-associated anaplastic large cell lymphoma: a prospective series of 52 patients. Ann. Surg. https://doi.org/10.1097/SLA.0000000000004035 (2020).

  23. Clemens, M. W. et al. Complete surgical excision is essential for the management of patients with breast implant-associated anaplastic large-cell lymphoma. J. Clin. Oncol. 34, 160–168 (2016).

    Article  CAS  PubMed  Google Scholar 

  24. Kadin, M. E. et al. Biomarkers provide clues to early events in the pathogenesis of breast implant-associated anaplastic large cell lymphoma. Aesthet. Surg. J. 36, 773–781 (2016).

    Article  PubMed  Google Scholar 

  25. Chung, L. et al. Interleukin-17 and senescent cells regulate the foreign body response to synthetic material implants in mice and humans. Sci. Transl. Med. https://doi.org/10.1126/scitranslmed.aax3799 (2020).

  26. Loch-Wilkinson, A. et al. Breast implant-associated anaplastic large cell lymphoma in Australia and New Zealand: high-surface-area textured implants are associated with increased risk. Plast. Reconstr. Surg. 140, 645–654 (2017).

    Article  CAS  PubMed  Google Scholar 

  27. Hallab, N. J., Samelko, L. & Hammond, D. The inflammatory effects of breast implant particulate shedding: comparison with orthopedic implants. Aesthet. Surg. J. 39, S36–S48 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  28. Parham, C. S. et al. Advising patients about breast implant associated anaplastic large cell lymphoma. Gland Surg. 10, 417–442 (2020).

    Article  Google Scholar 

  29. Hall-Findlay, E. J. Breast implant complication review: double capsules and late seromas. Plast. Reconstr. Surg. 127, 56–66 (2011).

    Article  CAS  PubMed  Google Scholar 

  30. Wolfram, D. et al. T regulatory cells and TH17 cells in peri-silicone implant capsular fibrosis. Plast. Reconstr. Surg. 129, 327–337 (2012).

    Article  CAS  Google Scholar 

  31. Chung, L. et al. Interleukin 17 and senescent cells regulate the foreign body response to synthetic material implants in mice and humans. Sci. Transl. Med. 12, eaax3799 (2020).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Flemming, R. G., Murphy, C. J., Abrams, G. A., Goodman, S. L. & Nealey, P. F. Effects of synthetic micro- and nano-structured surfaces on cell behavior. Biomaterials 20, 573–588 (1999).

    Article  CAS  PubMed  Google Scholar 

  33. Jain, N. & Vogel, V. Spatial confinement downsizes the inflammatory response of macrophages. Nat. Mater. 17, 1134–1144 (2018).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Madden, L. R. et al. Proangiogenic scaffolds as functional templates for cardiac tissue engineering. Proc. Natl Acad. Sci. USA 107, 15211–15216 (2010).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Kyle, D. J., Oikonomou, A., Hill, E. & Bayat, A. Development and functional evaluation of biomimetic silicone surfaces with hierarchical micro/nano-topographical features demonstrates favourable in vitro foreign body response of breast-derived fibroblasts. Biomaterials 52, 88–102 (2015).

    Article  CAS  PubMed  Google Scholar 

  36. Sforza, M. et al. Preliminary 3-year evaluation of experience with SilkSurface and VelvetSurface Motiva silicone breast implants: a single-center experience with 5813 consecutive breast augmentation cases. Aesthet. Surg. J. 38, S62–S73 (2018).

    Article  PubMed  Google Scholar 

  37. Doloff, J. C. et al. Colony stimulating factor-1 receptor is a central component of the foreign body response to biomaterial implants in rodents and non-human primates. Nat. Mater. 16, 671–680 (2017).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Vegas, A. J. et al. Combinatorial hydrogel library enables identification of materials that mitigate the foreign body response in primates. Nat. Biotechnol. 34, 345–352 (2016).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Veiseh, O. et al. Size- and shape-dependent foreign body immune response to materials implanted in rodents and non-human primates. Nat. Mater. 14, 643–651 (2015).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Anderson, J. M., Rodriguez, A. & Chang, D. T. Foreign body reaction to biomaterials. Semin. Immunol. 20, 86–100 (2008).

    Article  CAS  PubMed  Google Scholar 

  41. Kenneth Ward, W. A review of the foreign-body response to subcutaneously-implanted devices: the role of macrophages and cytokines in biofouling and fibrosis. J. Diabetes Sci. Technol. Online 2, 768–777 (2008).

    Article  CAS  Google Scholar 

  42. Bain, C. C. et al. Constant replenishment from circulating monocytes maintains the macrophage pool in the intestine of adult mice. Nat. Immunol. 15, 929–937 (2014).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Abbas, A., Lichtman, A. & Pillai, S. in Cellular and Molecular Immunology 8th edn (Elsevier Saunders, 2014).

  44. Efanov, J. I., Giot, J. P., Fernandez, J. & Danino, M. A. Breast-implant texturing associated with delamination of capsular layers: a histological analysis of the double capsule phenomenon. Ann. Chir. Plast. Esthet. 62, 196–201 (2017).

    Article  CAS  PubMed  Google Scholar 

  45. Glicksman, C. A., Danino, M. A., Efanov, J. I., El Khatib, A. & Nelea, M. A step forward toward the understanding of the long-term pathogenesis of double capsule formation in macrotextured implants: a prospective histological analysis. Aesthet. Surg. J. 39, 1191–1199 (2018).

    Article  Google Scholar 

  46. Maxwell, G. P., Scheflan, M., Spear, S., Nava, M. B. & Heden, P. Benefits and limitations of macrotextured breast implants and consensus recommendations for optimizing their effectiveness. Aesthet. Surg. J. 34, 876–881 (2014).

    Article  PubMed  Google Scholar 

  47. Farah, S. et al. Long-term implant fibrosis prevention in rodents and non-human primates using crystallized drug formulations. Nat. Mater. 18, 892–904 (2019).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Cappellano, G. et al. Immunophenotypic characterization of human T cells after in vitro exposure to different silicone breast implant surfaces. PLoS ONE 13, e0192108 (2018).

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  49. Katzin, W. E., Feng, L. J., Abbuhl, M. & Klein, M. A. Phenotype of lymphocytes associated with the inflammatory reaction to silicone gel breast implants. Clin. Diagn. Lab Immunol. 3, 156–161 (1996).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Wynn, T. A. & Ramalingam, T. R. Mechanisms of fibrosis: therapeutic translation for fibrotic disease. Nat. Med. 18, 1028–1040 (2012).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Sharabi, A. et al. Regulatory T cells in the treatment of disease. Nat. Rev. Drug Discov. 17, 823–844 (2018).

    Article  CAS  PubMed  Google Scholar 

  52. Watad, A. et al. Silicone breast implants and the risk of autoimmune/rheumatic disorders: a real-world analysis. Int J. Epidemiol. 47, 1846–1854 (2018).

    Article  PubMed  Google Scholar 

  53. Sadighi Akha, A. A. Aging and the immune system: an overview. J. Immunol. Methods 463, 21–26 (2018).

    Article  CAS  PubMed  Google Scholar 

  54. Durbin, J. E., Hackenmiller, R., Simon, M. C. & Levy, D. E. Targeted disruption of the mouse Stat1 gene results in compromised innate immunity to viral disease. Cell 84, 443–450 (1996).

    Article  CAS  PubMed  Google Scholar 

  55. O’Shea, J. J., Holland, S. M. & Staudt, L. M. JAKs and STATs in immunity, immunodeficiency, and cancer. N. Engl. J. Med. 368, 161–170 (2013).

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  56. Liu, M. et al. CXCL10/IP-10 in infectious diseases pathogenesis and potential therapeutic implications. Cytokine Growth Factor Rev. 22, 121–130 (2011).

    CAS  PubMed  PubMed Central  Google Scholar 

  57. Le Page, C., Genin, P., Baines, M. G. & Hiscott, J. Interferon activation and innate immunity. Rev. Immunogenet. 2, 374–386 (2000).

    CAS  PubMed  Google Scholar 

  58. Murray, P. J. et al. Macrophage activation and polarization: nomenclature and experimental guidelines. Immunity 41, 14–20 (2014).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

This work was supported by Establishment Labs. We thank members of the Establishment team for help with sourcing full-scale, commercial implants and manufacturing the miniaturized implants used in this study; M. C. Quiros for his clinical contributions; and D. Wolfram for critique on the presented data that went into this manuscript. The laboratory of H.C.H. is supported by Gabrielle’s Angel Foundation for Cancer Research. We acknowledge the use of resources at Core Facilities (Swanson Biotechnology Center, David H. Koch Institute for Integrative Cancer Research at MIT), W. M. Keck Biological Imaging Facility for Flow Cytometry and Histology, as well as the Division of Comparative Medicine for animal work, and the Sidney Kimmel Comprehensive Cancer Center (SKCCC) Immune Monitoring Core for additional NanoString analysis (at Johns Hopkins).

Author information

Author notes

  1. These authors contributed equally: Joshua C. Doloff, Omid Veiseh.

Authors and Affiliations

  1. David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA

    Joshua C. Doloff, Omid Veiseh & Robert Langer

  2. Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA

    Joshua C. Doloff, Omid Veiseh & Robert Langer

  3. Department of Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Joshua C. Doloff, Omid Veiseh & Robert Langer

  4. Department of Biomedical Engineering, Translational Tissue Engineering Center, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Joshua C. Doloff, Jessica L. Stelzel, Stuart J. Bauer & Sarah Y. Neshat

  5. Department of Materials Science and Engineering, Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, MD, USA

    Joshua C. Doloff

  6. Department of Bioengineering, Rice University, Houston, TX, USA

    Omid Veiseh, Amanda Nash, Samira Aghlara-Fotovat & H. Courtney Hodges

  7. Establishment Labs Holdings, Alajuela, Costa Rica

    Roberto de Mezerville, Tracy Ann Perry, John Hancock, Natalia Araujo Romero, Yessica Elizondo Hidalgo & Isaac Mora Leiva

  8. Division of Plastic Surgery, Dolan Park Hospital, Birmingham, UK

    Marcos Sforza

  9. Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA, USA

    Jennifer Haupt & Morgan Jamiel

  10. Translational Biology and Molecular Medicine Graduate Program, Baylor College of Medicine, Houston, TX, USA

    Courtney Chambers

  11. Breast Surgery Group, Plastic Surgery Division, University of São Paulo School of Medicine, São Paulo, Brazil

    Alexandre Mendonça Munhoz

  12. Plastic Surgery Department, Hospitals Sirio-Libanês and Moriah, São Paulo, Brazil

    Alexandre Mendonça Munhoz

  13. Plastic and Reconstructive Surgery Research, NIHR Biomedical Research Centre, University of Manchester, Manchester, UK

    Ardeshir Bayat

  14. Division of Plastic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Brian M. Kinney

  15. Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA

    H. Courtney Hodges

  16. Center for Cancer Epigenetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    H. Courtney Hodges

  17. Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, USA

    H. Courtney Hodges

  18. Department of Hematopathology, Division of Pathology/Lab Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Roberto N. Miranda

  19. Department of Plastic Surgery, University of Texas, MD Anderson Cancer Center, Houston, TX, USA

    Mark W. Clemens

  20. Harvard-MIT Division of Health Science Technology, Massachusetts Institute of Technology, Cambridge, MA, USA

    Robert Langer

  21. Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA

    Robert Langer

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  1. Joshua C. Doloff
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Contributions

J.C.D., O.V. and R.L. designed the studies, analysed data and wrote the paper. J.C.D., O.V., M.S., J. Haupt, M.J., C.C., A.N., S.A.-F., J.L.S., S.J.B., S.Y.N., N.A.R., Y.E.H., I.M.L., H.C.H., R.N.M. and M.W.C. conducted the experiments. J.C.D., H.C.H. and O.V. carried out the statistical analyses and prepared displays communicating datasets. R.d.M., M.S., T.A.P., J. Hancock, A.M.M., A.B., B.M.K. and R.L. provided advice and technical support throughout, and J.C.D., O.V. and R.L. contributed with supervision of the study. All authors discussed the results and the preparation of the paper.

Corresponding authors

Correspondence to Joshua C. Doloff, Omid Veiseh, Roberto de Mezerville or Robert Langer.

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Competing interests

J.H., A.B., B.K., T.A.P and R.L. are members of the Scientific Advisory Board of Establishment Labs Holdings and each hold equity in the company. M.S. and A.M.M. are members of the Medical Advisory Board and each hold equity in Establishment Labs Holdings. M.W.C. and B.M.K. are Investigators on the US IDE Clinical Trial for the Study of Safety and Effectiveness of Motiva Implants. R.D.M., N.A.R., Y.E.H. and I.M.L. are employees of Establishment Labs S.A., and hold equity in Establishment Labs Holdings. J.C.D. and O.V. are paid consultants for Establishment Labs S.A. For a list of entities with which R.L. is involved, compensated or uncompensated, see the listing in the Supplementary Information.

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Peer review information Nature Biomedical Engineering thanks Pamela Moalli and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Supplementary information

Supplementary Information

Supplementary figures, tables, video captions, references and additional detailed competing interests.

Reporting Summary

Supplementary Video 1

Double capsules for Mentor Siltex.

Supplementary Video 2

Double capsule for Allergan Microcell, with Velcro effect.

Supplementary Video 3

Double capsule for Allergan Biocell, with Velcro effect.

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Doloff, J.C., Veiseh, O., de Mezerville, R. et al. The surface topography of silicone breast implants mediates the foreign body response in mice, rabbits and humans. Nat Biomed Eng 5, 1115–1130 (2021). https://doi.org/10.1038/s41551-021-00739-4

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