Tumour Necrosis Factor-α Expression Is Associated with Increased Severity of Periprosthetic Breast Capsular Contracture

<i>Background:</i> The pathogenesis of periprosthetic capsular contracture following breast implant surgery is unclear. The aim of this study was to identify the expression of tumour necrosis factor-α (TNF-α), collagen type III α₁ (COL3A1), transforming growth factor-β₁ (TGF-β₁) and connective tissue growth factor (CTGF) in different Baker grades of breast capsular contracture. <i>Methods:</i> Seven periprosthetic breast capsule specimens were collected from 6 patients. TNF-α, COL3A1, TGF-β₁ and CTGF gene expression were analysed using real-time quantitative polymerase chain reaction. Immunohistolocalisation of TNF-α was performed on paraffin-embedded sections. Significant correlations were analysed using the Pearson correlation coefficient. <i>Results:</i> TNF-α expression was associated with increased Baker grade of capsular contracture (Pearson correlation, r = 0.558; p = 0.02). COL3A1 gene expression was reduced with increasing severity of contracture (r = –0.490; p = 0.05). There were no significant correlations between TGF-β₁ and CTGF expression with Baker grade. Positive TNF-α staining in breast capsules was localised to fibroblasts, macrophages, and extracellularly close to the prosthesis. <i>Conclusion:</i> The increased expression of TNF-α may play a key role in the inflammatory response associated with capsular contracture. The corresponding decrease in COL3A1 may contribute to the change in capsular physical properties seen in capsular contracture.