Acellular Dermal Matrix Reduces Myofibroblast Presence in the Breast Capsule

Abstract

Background: Capsular contracture remains a common complication after implant-based breast reconstruction. Previous work has suggested that the use of acellular dermal matrix (ADM) reduces the rate of capsular contracture, though little is understood about the underlying mechanism. As myofibroblasts are believed to be the key cells implicated in contracture formation, we hypothesized that ADM would result in a reduction in periprosthetic myofibroblast concentration. Methods: Five patients who underwent immediate prepectoral tissue expander placement with anterior ADM coverage and an inferior cuff were included. At the second stage, tissue samples were obtained of both ADM and capsule from each reconstructed breast. Samples were then prepared for hematoxylin and eosin staining and immunohistochemistry for myofibroblast identification (alpha smooth muscle actin and vimentin positive and desmin negative) and analysis. Experimental values are presented as mean ± SD unless otherwise stated. Statistical significance was determined using unpaired t test. Results: Successful incorporation of ADM was noted in all cases. A significant reduction in myofibroblast concentration was noted in the ADM versus the capsule ( P = 0.0018). This was paralleled by significantly thicker periprosthetic capsule formation overlying the formerly raw pectoralis major muscle, that is, not covered by ADM ( P < 0.0001). Conclusions: In the presence of ADM, there are significantly fewer myofibroblasts in breast capsules and thinner capsules on histology. Given the central role of myofibroblasts in the development of clinically significant capsular contracture, this study unmasks a possible mechanism for the protective effect of ADM with respect to capsular contracture development.

Direct comparison of CGCRYODERM and DermACELL in the same patient for outcomes in bilateral implant-based breast reconstruction: a retrospective case series

“…Although the histological examination was performed in a single case, the result showed more decreased number of myofibroblasts in the CGCRYODEROM capsule. It is reported that decreased presence of myofibroblasts is related to reduced capsular contracture rates with addition of ADM in IBR (27,30,31).…”

Current Concepts in Capsular Contracture: Pathophysiology, Prevention, and Management

“…24 Limited other data exist directly comparing the specific inflammatory response in the breast implant capsule based on adjacent tissue type. However, capsule adjacent to ADM compared with capsule against muscle in the same breast shows significantly reduced inflammation and cellularity in capsule against ADM. [25][26][27][28] This, coupled with the fact that ADM appears to reduce capsular contracture, raises the possibility that adjacent tissues drive periprosthetic inflammation, and that ADM shields the implant from this inflammatory response. 8,9 Another plane-specific consideration is that breast parenchyma also possesses low levels of bacterial colonization.…”

Braxon®-assisted prepectoral breast reconstruction: A decade later

“…In such a scenario, even if autologous procedures remain excellent reconstructive strategies, their very long operating times, the need for donor site availability, and the associated possible complications explain why many surgeons opt for the simpler and faster implant-based reconstruction (IBR), currently the most common approach ( 4 , 9 , 10 ). In this regard, although improvements in silicone implant safety and fat grafting techniques have been contributing to the growth of prosthetic reconstruction ( 6 , 11 ), the historical development of IBR has been accompanied first by the introduction and then by the evolution of several generations of collagen-based materials such as acellular dermal matrices (ADMs) ( 12 , 13 ).…”