title: Experimental total wrapping of breast implants with acellular dermal matrix: a preventive tool against capsular contracture in breast surgery?
abstract: BACKGROUND
  Capsular contracture remains a hitherto unsolved complication after implantation of silicone gel-filled breast prostheses. Based on clinical and experimental data, the use of an acellular dermal matrix as a sheath around implants may lead to lesser capsular contracture acting as a proposed biological environment mimicking wound bed tissue. The aim of our study was to analyse the tissue reaction after implantation of silicone prosthesis with and without an envelope of acellular dermal matrix.
  
  
  METHODS
  Implantation of 60 silicone prostheses in the back of Lewis rats were carried out, randomly paired taking one rat from group A and one from group B. Group A included implants completely enveloped with xenogenic acellular dermis and group B undraped silicone implants. At 3, 6 and 12 weeks postoperatively, the samples were explanted and subjected to histological and immunohistochemical evaluation.
  
  
  RESULTS
  A new myofibroblast tissue layer was identified in proximity to the implant in both groups. The thickness of the layer in group A was continuously thinner than in group B regarding the different explantation time points. Implants completely wrapped with acellular dermal matrix showed significantly lesser inflammatory signs at 3 and 12 weeks after implantation compared to controls. Cell proliferation after 12 weeks was significantly decreased in group A.
  
  
  CONCLUSIONS
  The slight myofibroblast layer and reduced rate of inflammation and proliferation in the treatment group show a positive effect of total acellular dermal matrix envelope and hypothesise the decrease of capsular contracture in long-term periods.
authors.affiliation: Department of Plastic and Hand Surgery, Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany. marweh.schmitz@uk-erlangen.de
authors.forename: Marweh
authors.initials: M
authors.lastname: Schmitz
authors.forename: Martin
authors.initials: M
authors.lastname: Bertram
authors.forename: Ulrich
authors.initials: U
authors.lastname: Kneser
authors.forename: Andrea K
authors.initials: AK
authors.lastname: Keller
authors.forename: Raymund E
authors.initials: RE
authors.lastname: Horch
mesh_terms: D062088:Acellular Dermis; D000818:Animals; D019928:Breast Implantation / Q000379:methods*; D018427:Breast Implants; D003286:Contracture / Q000473:pathology* / Q000517:prevention & control*; D005782:Gels; D007150:Immunohistochemistry; D011183:Postoperative Complications / Q000473:pathology* / Q000517:prevention & control*; D011474:Prosthesis Design; D011897:Random Allocation; D051381:Rats; D011917:Rats, Inbred Lew; D012828:Silicones
chemical_list: D005782:Gels; D012828:Silicones
keywords: Acellular dermal matrix; Capsular contracture; Silicone breast implants; Total wrapping of implants