Quo vadis? Brustimplantate – aktuelle Entwicklungen und neue Konzepte

Zusammenfassung

Hintergrund:

Brustaugmentationen gehören zu den am häufigsten von Plastischen Chirurgen durchgeführten operativen Eingriffen und in der Mehrzahl der Brustrekonstruktionen werden Implantate bis dato verwendet. Der Artikel bietet eine Übersicht über die neuesten Konzepte zur Erhöhung der Biokompatibilität von Brustimplantaten und Reduktion der Kapselkontraktur mit dem Fokus auf Oberflächenmodifikationen und Biomaterialien. Aufgrund der aktuellen Ereignisse die PIP^®-Implantate betreffend wird ein kurzer Beitrag dazu ebenfalls präsentiert.

Materialien und Methoden:

Zur Informationsgewinnung wurden die Datenbanken PubMed, Embase und Cochrane Collaboration nach experimentellen und klinischen Studien, sowie Metaanalysen und Reviews durchsucht. Anhand des Titels, des Erscheinungsjahres und der Abstracts wurden thematisch relevante aktuelle Publika­tionen in englischer oder deutscher Sprache ausgewählt und die Volltextartikel studiert.

Ergebnisse:

Seit den 60er Jahren sind je nach Klassifikationssystem 4–5 Generationen von Brustimplantaten erschienen. Veränderungen betrafen unterschiedliche Bereiche. Die Oberflächenbeschaffenheit wurde durch unterschiedliche Texturen sowie die Beschichtung mit Polyurethan oder Titan modifiziert. Einige dieser Veränderungen zeigten zwar einen gewissen Erfolg in der Reduktion der Kapselkontraktur, konnten jedoch dieses Problem bisher nicht ausreichend lösen. In aktuellen experimentellen Studien wurde die Oberfläche meist durch antifibrotische oder antibakterielle Substanzen modifiziert. Für die lokale Freisetzung von der Implantatoberfläche wurden verschiedene Trägermedien verwendet. Auch die Medikamentenapplikation durch eine kovalente Bindung an die Implantatoberfläche oder Oberflächenimprägnierung wurde untersucht. Die Erhöhung der Biokompatibilität durch Biomimikry oder nanotechnologische Veränderung der Biomaterialien stellen weitere Ansätze dar, die zukünftig zur Reduktion der Kapselkontraktur beitragen könnten.

Schlussfolgerung:

Die Entwicklung von Beschichtungen zur kontrollierten lokalen Medikamentenfreisetzung von der Implantatoberfläche könnte zukünftig genutzt werden, um weitere Medikamente zu verabreichen, die in klinischen Studien in oraler Applikation eine Reduktion der Kapselkontraktur bewirkt haben. Damit könnte das Risiko von unerwünschten Arzneimittelwirkungen möglicherweise gesenkt werden. Ungeklärte Fragen zu kontrollierten Drug-Release-Systemen, Langzeitergebnissen sowie möglichen systemischen Nebenwirkungen von Medikamenten in kontinuierlicher lokaler Applikation könnten in weiteren Studien geklärt werden.

Abstract

Background:

Breast augmentation is one of the most frequent surgical procedures performed by plastic surgeons. Furthermore, in the majority of breast reconstructions implants are still in use. With the focus on surface modifications and biomaterials, the article provides an overview of the latest trends and concepts in increase of implant biocompatibility and reduction of capsular contracture. Because of the recent events regarding PIP^® implants, a short report on this topic is presented as well.

Materials and Methods:

The literature was searched for experimental and clinical studies, as well as meta-analysis and reviews, using the databases PubMed, Embase and Cochrane Collaboration. Based on the title, year of publication and abstracts, thematically relevant and recent publications in English or German were selected and full text articles were studied.

Results:

According to the classification, 4–5 generations of breast implants have been developed since the 1960s. Modifications affected diverse areas including various surface textures as well as coatings with polyurethane or titanium. Some of these changes were able to reduce capsular contracture, however, without resolving the issue sufficiently. Recent experimental studies mostly evaluated different surface coatings with antifibrotic and antibacterial substances. For the local drug release various carrier subs­tances were used. Furthermore, drugs were covalently bonded to the implant surface or applied by surface impregnation. In different approaches biocompatibility could be increased by biomimicry or nanotechnologically modified biomaterials, which could additionally contribute to the reduction of capsular contracture.

Conclusion:

The development of coating technologies for the locally controlled sustained drug release using the implant surface as drug delivery system could potentially enable the local administration of drugs, which were orally delivered in clinical trials, and effectively reduced capsular contracture. This kind of application could potentially minimize the risk of adverse side effects. However, there are still some questions concerning controlled drug release systems for implant surfaces, as well as long-term results and possible side effects of drugs in a continuous local administration to be answered in further studies.

Schlüsselwörter

beschichtete Brust­implantate - Kapselfibrose - Oberflächenmodifikation - Freisetzung von Medika­menten - PIP Implantate

Key words

coated breast implants - capsular contracture - surface modification - drug release systems - PIP implants

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