Implantable Medical Devices, Biomaterials, and the Foreign Body Response: A Surgical Perspective

Implantable medical devices improve quality of life and reduce mortality by restoring the form and function of the human body. Their biomaterial surface components in contact with tissues are, however, susceptible to the host's foreign body response, which drives inflammation and implant fibrous encapsulation. When dysregulated, this response causes implant-related patient morbidity and device failure, ultimately requiring revision surgery. Here, we review the roles that the biomaterial, the host, and the implantation surgery play in the foreign body response. Taking commonly-used implantable medical devices as examples, we first describe the foreign body response; then, we examine the factors influencing it, and finally, we propose ideas of how it can be controlled perioperatively in an attempt to minimize implant-related complications.