Comparison of inflammatory response and synovial metaplasia in immediate breast reconstruction with a synthetic and a biological mesh: a randomized controlled clinical trial

Abstract

The aim of this study was to compare inflammatory response and synovial metaplasia in implant-based immediate breast reconstruction with a biological mesh (Veritas V R) with that of a synthetic mesh (TIGR V R Matrix Surgical Mesh). We hypothesize that the inflammatory response and formation of synovial metaplasia might be different and the rate of capsular contracture therefore different. The patients were recruited from the Gothenburg TIGR V R /Veritas V R Study (ClinicalTrials.Gov identifier NCT02985073). All referrals for bilateral immediate breast reconstruction were assessed for inclusions. During the operation, the patients were randomized to which sides the biological and the synthetic mesh were going to be applied. During the implant exchange biopsies were taken. Biopsies were taken from 30 breasts in 15 patients. There seem to be more myofibroblast and neovascularization in the biological meshes than in the synthetic and the collagen fibers seem to be aligned in an irregular pattern with both parallel and vertical fibers. In the synthetic meshes, there were more giant cells and foreign body reaction and the collagen fibers were loosely and well aligned, oriented parallel to the surface of the implant. Synovial metaplasia was seen in the majority of both the biological and the synthetic meshes. The histological patterns in early capsules from biological and synthetic meshes vary considerably. Nonetheless, it is unknown what role different cell types have in capsular formation in the long run and there was no difference in clinical capsular contracture at the clinical follow-up in this study.

Comparison of one-stage direct-to-implant with acellular dermal matrix and two-stage immediate implant-based breast reconstruction—a cohort study

“…In a recent study more myofibroblast and neovascularization were observed in the capsule of breasts reconstructed with biological mesh than in breasts reconstructed with synthetic mesh. Furthermore, collagen fibers seemed to be aligned in an irregular pattern with both parallel and vertical fibers (25). However, this difference in formation of capsular tissue was not reflected in the frequency of capsular contracture maybe due to a follow-up time of less than two years.…”

Drain secretion and seroma formation after immediate breast reconstruction with a biological and a synthetic mesh, respectively: A randomized controlled study

“…This suggest that the significantly higher seroma production occurs late during the postoperative healing phase and contradicts the theory of an acute inflammatory reaction in the early stage of the wound healing process. 12 Even though the synthetic meshes provoke more inflammation and foreign body reaction, 14 it does not seem to be the deciding factor in the amount of seroma produced. The biological meshes seem to be more prone to produce seroma.…”

“…As such, the matrix can be considered a xenograft/allograft whereas the mesh is more of a foreign material. Indeed, biopsies from early capsules from biological and synthetic meshes display different tissue reaction 14 . It has been hypothesized that additional synthetic material might lead to a prolonged inflammatory response contributing to a longer drain time 12 .…”

First‐year complications after immediate breast reconstruction with a biological and a synthetic mesh in the same patient: A randomized controlled study

“…The body reacts differently to synthetic and biological meshes. A previous study conducted in our department 9 demonstrated that there are different histological patterns in early capsules from biological matrices and synthetic meshes. It has been speculated that biological meshes give a better long-term result and a decreased risk for capsular contracture.…”