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REVIEW article

Front. Bioeng. Biotechnol.

Sec. Biomaterials

Volume 13 - 2025 | doi: 10.3389/fbioe.2025.1668930

Biomimetic Optimization of Silicone Breast Implant Integration: Insights into Wound Healing and the Foreign Body Response

Provisionally accepted
Kevin  DzoboKevin Dzobo1Traci  Ann WilgusTraci Ann Wilgus2Vanessa  Zamora MoraVanessa Zamora Mora3Audry  ZoncsichAudry Zoncsich3Roberto  De MezervilleRoberto De Mezerville3Nonhlanhla  P KhumaloNonhlanhla P Khumalo1ARDESHIR  BAYATARDESHIR BAYAT1*
  • 1University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
  • 2The Ohio State University, Columbus, United States
  • 3Establishment Labs Holdings SA, Alajuela, Costa Rica

The final, formatted version of the article will be published soon.

Breast augmentation is the most prevalent aesthetic surgical procedure worldwide. While silicone breast implants have evolved in terms of safety and biocompatibility, they inevitably trigger a foreign body response (FBR). This complex process can lead to fibrous encapsulation, capsular contracture, and other complications, often necessitating invasive revision surgeries. This review comprehensively analyzes the molecular and cellular mechanisms underlying FBR, emphasizing the crucial role of implant surface properties. We demonstrate how these properties, including topography, hydrophobicity, and charge, govern the initial protein adsorption patterns, effectively establishing a "molecular fingerprint" that dictates subsequent cellular interactions. This, in turn, orchestrates immune cell activation, notably macrophages, which exhibit plasticity in their polarization into pro-inflammatory (M1) and pro-fibrotic (M2) phenotypes. The balance between these phenotypes influences the extent of fibrosis and capsular contracture. We explored the five distinct phases of FBR: protein adsorption, acute inflammation, chronic inflammation, foreign body giant cell (FBGC) formation, and encapsulation. The impact of implant surface properties on each phase was elucidated, highlighting the dynamic interplay between macrophages, lymphocytes, and matrix. The phenomenon of "frustrated phagocytosis," where macrophages fail to engulf the implant, leading to FBGC formation and chronic inflammation, is also examined. Finally, we explore promising strategies to modulate FBR and enhance implant biocompatibility, including biomimetic coatings, the use of decellularized matrices, and therapies aimed at disrupting specific molecular pathways involved in fibrosis. This review provides insights into the development of next-generation implants that can harmoniously integrate with the body, minimizing FBR and ensuring long-term clinical success.

Keywords: Wound Healing, Foreign body response, Silicone implant, protein adsorption, Inflammation, Extracellular Matrix, Fibrosis

Received: 18 Jul 2025; Accepted: 01 Sep 2025.

Copyright: © 2025 Dzobo, Wilgus, Mora, Zoncsich, De Mezerville, Khumalo and BAYAT. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: ARDESHIR BAYAT, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.