Surface texturation of breast implant impacts extracellular matrix and inflammatory gene expression in asymptomatic capsule.

BACKGROUND Texturing processes have been designed to improve biocompatibility and mechanical anchoring of breast implants. However, high texturing degree has been associated with severe pathologies. Here, we aimed to determine whether implant surface topography could also affect physiology of asymptomatic capsules. METHODS We collected topographical measurements from 17 different breast implant devices by interferometry and X-ray microtomography. Morphological structures were statistically analyzed to obtain a robust breast implant surface classification. We obtained 3 topographical categories of textured implants ("peak and valleys", "open cavities", and "semi-opened cavities") based on the cross-sectional aspects. We simultaneously collected 31 Baker I capsules, sorted them according to the new classification, established their molecular profile, and examined the tissue organization. RESULTS Each of the categories showed distinct expression patterns of genes associated with the extracellular matrix (Timp and Mmp members) and inflammatory response (Saa1, Tnsf11, Il8), despite originating from healthy capsules. Besides, slight variations were observed in the organization of capsular tissues at the histological level. CONCLUSIONS We combined a novel surface implant classification system and gene profiling analysis to show that implant surface topography is a bioactive cue that can trigger gene expression changes in surrounding tissue, even in Baker I capsules. Our new classification system avoids confusions around the word "texture", and could be transposed to implant ranges of every manufacturer. This new classification could prove useful in studies on potential links between specific texturations and the incidence of certain breast-implant associated complications.