Capsular contracture in implant based breast reconstruction—the effect of porcine acellular dermal matrix

Lardi, Alessia M.; Ho-Asjoe, Mark; Junge, Klaus; Farhadi, Jian

doi:10.21037/gs.2017.01.02

Cited by 41 publications

(40 citation statements)

References 34 publications

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“…The role of ADM in the prevention of periprosthetic fibrosis was evaluated in several papers, also before the conception of PPBR, and its positive effect was confirmed in mutual agreement 27,28 . Moreover, the study by Onesti et al 4 described the specific behavior of the ADM Braxon confirming, through ultrasound and histologic examinations, the formation of a new layer in the subcutaneous tissue that is less prone to contract during the years.…”

Section: Discussionmentioning

confidence: 92%

The largest multicentre data collection on prepectoral breast reconstruction: The iBAG study

Masià

2020

Journal of Surgical Oncology

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Background and Objectives In the last years, prepectoral breast reconstruction has increased its popularity, becoming a standard reconstructive technique by preserving pectoralis major anatomy and functionality. Nevertheless, the lack of solid and extensive data negatively impacts on surgeons’ correct information about postoperative complication rates and proper patient selection. This study aims to collect the largest evidence on this procedure. Methods A multicentre retrospective audit, promoted by the Barcelona Hospital, collected the experience of 30 centers on prepectoral breast reconstruction with Braxon ADM. The study had the scientific support of INPECS and IIB societies which provided the online database Clinapsis. Results A total of 1450 procedures were retrospectively collected in a 6‐year period. Mean age 52.4 years, BMI 23.9, follow‐up 22.7 months. Reconstruction was carried out after a tumor in 77.1% of the cases, 20.1% had prophylactic surgery, 2.8% had revisions. Diabetes, smoke, and immunosuppression had an influence on complications occurrence, as well as implant weight. Capsular contracture was associated with postoperative radiotherapy, but the overall rate was low (2.1%). Complications led to implant loss in 6.5% of the cases. Conclusions The international Braxon Audit Group multicentre data collection represents a milestone in the field of breast reconstruction, extensively improving the knowledge on this procedure.

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Section: Discussionmentioning

confidence: 92%

The largest multicentre data collection on prepectoral breast reconstruction: The iBAG study

Masià

2020

Journal of Surgical Oncology

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“…Radiotherapy, before or after implant reconstruction has also been shown to lead to high rates of capsular contracture and decreased patient satisfaction [36] . Recent data to suggest that ADM may offer protection against the adverse effects of radiotherapy [37] , [38] may explain why the majority of centres do not consider this to be a contraindication to mesh-assisted IBBR. Data to support the proposed benefits, however are limited [39] .…”

Section: Discussionmentioning

confidence: 99%

Variation in the provision and practice of implant-based breast reconstruction in the UK: Results from the iBRA national practice questionnaire

Williamson¹,

Cutress²,

Gardiner³

et al. 2017

The Breast

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IntroductionThe introduction of biological and synthetic meshes has revolutionised the practice of implant-based breast reconstruction (IBBR) but evidence for effectiveness is lacking. The iBRA (implant Breast Reconstruction evAluation) study is a national trainee-led project that aims to explore the practice and outcomes of IBBR to inform the design of a future trial. We report the results of the iBRA National Practice Questionnaire (NPQ) which aimed to comprehensively describe the provision and practice of IBBR across the UK.MethodsA questionnaire investigating local practice and service provision of IBBR developed by the iBRA Steering Group was completed by trainee and consultant leads at breast and plastic surgical units across the UK. Summary data for each survey item were calculated and variation between centres and overall provision of care examined.Results81 units within 79 NHS-hospitals completed the questionnaire. Units offered a range of reconstructive techniques, with IBBR accounting for 70% (IQR:50–80%) of participating units' immediate procedures. Units on average were staffed by 2.5 breast surgeons (IQR:2.0–3.0) and 2.0 plastic surgeons (IQR:1.0–3.0) performing 35 IBBR cases per year (IQR:20-50). Variation was demonstrated in the provision of novel different techniques for IBBR especially the use of biological (n = 62) and synthetic (n = 25) meshes and in patient selection for these procedures.ConclusionsThe iBRA-NPQ has demonstrated marked variation in the provision and practice of IBBR in the UK. The prospective audit phase of the iBRA study will determine the safety and effectiveness of different approaches to IBBR and allow evidence-based best practice to be explored.

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“…A particularly challenging problem in implant-based reconstruction is the development of capsular contracture. 2,3,12,13 Its clinical manifestation ranges from a palpable to a visible and painful deformity, with a reported incidence of >10%. 2,3,12,13 In fact, it remains one of the most commonly reported complications in implant-based breast surgery.…”

Section: Introductionmentioning

confidence: 99%

Acellular Dermal Matrix Reduces Myofibroblast Presence in the Breast Capsule

Tevlin

Borrelli

Irizarry

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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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.

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Capsular contracture in implant based breast reconstruction—the effect of porcine acellular dermal matrix

Cited by 41 publications

References 34 publications

The largest multicentre data collection on prepectoral breast reconstruction: The iBAG study

The largest multicentre data collection on prepectoral breast reconstruction: The iBAG study

Variation in the provision and practice of implant-based breast reconstruction in the UK: Results from the iBRA national practice questionnaire

Acellular Dermal Matrix Reduces Myofibroblast Presence in the Breast Capsule

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