title: The impact of chemotherapy and radiation therapy on the remodeling of acellular dermal matrices in staged, prosthetic breast reconstruction.
abstract: BACKGROUND
  An acellular dermal matrix will typically incorporate, in time, with the overlying mastectomy skin flap. This remodeling process may be adversely impacted in patients who require chemotherapy and radiation, which influence neovascularization and cellular proliferation.
  
  
  METHODS
  Multiple biopsy specimens were procured from 86 women (n = 94 breasts) undergoing exchange of a tissue expander for a breast implant. These were divided by biopsy location: submuscular capsule (control) as well as superiorly, centrally, and inferiorly along the paramedian acellular dermis. Specimens were assessed for cellular infiltration, cell type, fibrous encapsulation, scaffold degradation, extracellular matrix deposition, neovascularization, mean composite remodeling score, and type I and III collagen. Patients were compared based on five oncologic treatment groups: no adjuvant therapy (untreated), neoadjuvant chemotherapy with or without radiation, and chemotherapy with or without radiation.
  
  
  RESULTS
  Biopsy specimens were procured 45 to 1805 days after implantation and demonstrated a significant reduction in type I collagen over time. Chemotherapy adversely impacted fibrous encapsulation (p = 0.03). Chemotherapy with or without radiation adversely impacted type I collagen (p = 0.02), cellular infiltration (p < 0.01), extracellular matrix deposition (p < 0.04), and neovascularization (p < 0.01). Radiation exacerbated the adverse impact of chemotherapy for several remodeling parameters. Neoadjuvant chemotherapy also caused a reduction in type I (p = 0.01) and III collagen (p = 0.05), extracellular matrix deposition (p = 0.03), and scaffold degradation (p = 0.02).
  
  
  CONCLUSIONS
  Chemotherapy and radiation therapy limit acellular dermal matrix remodeling.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: St. Louis, Mo.; and Cleveland, Ohio From the Division of Plastic and Reconstructive Surgery, the Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine; and the Department of Anatomic Pathology, Cleveland Clinic.
authors.forename: Terence M
authors.initials: TM
authors.lastname: Myckatyn
authors.forename: Jaime A
authors.initials: JA
authors.lastname: Cavallo
authors.forename: Ketan
authors.initials: K
authors.lastname: Sharma
authors.forename: Noopur
authors.initials: N
authors.lastname: Gangopadhyay
authors.forename: Jason R
authors.initials: JR
authors.lastname: Dudas
authors.forename: Andres A
authors.initials: AA
authors.lastname: Roma
authors.forename: Sara
authors.initials: S
authors.lastname: Baalman
authors.forename: Marissa M
authors.initials: MM
authors.lastname: Tenenbaum
authors.forename: Brent D
authors.initials: BD
authors.lastname: Matthews
authors.forename: Corey R
authors.initials: CR
authors.lastname: Deeken
mesh_terms: D062088:Acellular Dermis / Q000187:drug effects* / Q000528:radiation effects*; D000328:Adult; D019928:Breast Implantation; D001943:Breast Neoplasms / Q000628:therapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies