title: Further evidence that human acellular dermal matrix decreases inflammatory markers of capsule formation in implant-based breast reconstruction.
abstract: BACKGROUND
  Human acellular dermal matrix (HADM; previously termed "acellular cadaveric dermis") may limit inflammatory changes believed to play a role in capsular contracture, a common complication of implant-based breast reconstruction.
  
  
  OBJECTIVE
  Differences between HADM and native breast capsule specimens were evaluated by immunohistochemical analysis of key inflammatory markers involved in capsule formation.
  
  
  METHODS
  Twenty consecutive patients underwent immediate, 2-stage, implant-based breast reconstruction with dual-plane HADM. During tissue expander-implant exchange, full-thickness biopsies of biointegrated HADM and native breast capsule (internal control) from the tissue-expander envelope were obtained. Immunohistochemical analysis was performed for endothelial cells (CD31), B cells (CD20), T cells (CD3), macrophages (CD68), collagen I and III, and myofibroblasts (α-smooth muscle actin). Observed levels of marker labeling were semiquantitatively scored from 0 (none) to 3 (severe) by a blinded histopathologist and were statistically analyzed with the Wilcoxon rank sum test.
  
  
  RESULTS
  A bilateral sample was obtained from 1 patient; all other samples were unilateral. Compared with capsule samples from native breast tissue, HADM samples had significantly lower levels of all inflammatory markers (P < .001).
  
  
  CONCLUSIONS
  These lower levels of inflammatory markers support previous evidence that HADM may inhibit inflammatory and profibrotic signaling characteristics of breast capsule development and decrease the risk of capsular contracture. Further investigation is needed to determine the mechanism by which HADM inhibits these inflammatory cells, whether HADM reduces the incidence of breast capsular contracture, and if so, the longevity of this effect.
authors.affiliation: Dr Leong is a plastic surgeon at Michael E. DeBakey VA Medical Center, and Clinical Assistant Professor of Surgery and Pediatrics, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas. Dr Basu is a plastic surgeon in private practice in Houston, Texas. Dr Hicks is a professor in the Department of Pathology, Baylor College of Medicine, Houston, Texas.
authors.forename: Mimi
authors.initials: M
authors.lastname: Leong
authors.affiliation: Dr Leong is a plastic surgeon at Michael E. DeBakey VA Medical Center, and Clinical Assistant Professor of Surgery and Pediatrics, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas. Dr Basu is a plastic surgeon in private practice in Houston, Texas. Dr Hicks is a professor in the Department of Pathology, Baylor College of Medicine, Houston, Texas.
authors.forename: C Bob
authors.initials: CB
authors.lastname: Basu
authors.affiliation: Dr Leong is a plastic surgeon at Michael E. DeBakey VA Medical Center, and Clinical Assistant Professor of Surgery and Pediatrics, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas. Dr Basu is a plastic surgeon in private practice in Houston, Texas. Dr Hicks is a professor in the Department of Pathology, Baylor College of Medicine, Houston, Texas.
authors.forename: M John
authors.initials: MJ
authors.lastname: Hicks
mesh_terms: D062088:Acellular Dermis; D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D001706:Biopsy; D001940:Breast / Q000276:immunology / Q000473:pathology / Q000601:surgery*; D019928:Breast Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D018427:Breast Implants; D015536:Down-Regulation; D005260:Female; D005355:Fibrosis; D006801:Humans; D007150:Immunohistochemistry; D057910:Implant Capsular Contracture / Q000276:immunology / Q000473:pathology / Q000517:prevention & control*; D018836:Inflammation Mediators / Q000378:metabolism*; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators