The effect of post-mastectomy radiation therapy on breast implants: Unveiling biomaterial alterations with potential implications on capsular contracture.
Post-mastectomy breast reconstruction with expanders and implants is recognized as an integral part of breast cancer treatment. Its main complication is represented by capsular contracture, which leads to poor expansion, breast deformation, and pain, often requiring additional surgery. In such a scenario, the debate continues as to whether the second stage of breast reconstruction should be performed before or after post-mastectomy radiation therapy, in light of potential alterations induced by irradiation to silicone biomaterial. This work provides a novel, multi-technique approach to unveil the role of radiotherapy in biomaterial alterations, with potential involvement in capsular contracture. Following irradiation, implant shells underwent mechanical, chemical, and microstructural evaluation by means of tensile testing, Attenuated Total Reflectance Fourier Transform InfraRed spectroscopy (ATR/FTIR), Scanning Electron Microscopy (SEM), high resolution stylus profilometry, and Time of Flight Secondary Ion Mass Spectrometry (ToF-SIMS). Our findings are consistent with radiation-induced modifications of silicone that, although not detectable at the microscale, can be evidenced by more sophisticated nanoscale surface analyses. In light of these results, biomaterial irradiation cannot be ruled out as one of the possible co-factors underlying capsular contracture.
Department of Plastic Surgery, "Sapienza" University of Rome, Viale del Policlinico 155, 00166 Rome, Italy.
Diego
D
Ribuffo
Department of Plastic Surgery, "Sapienza" University of Rome, Viale del Policlinico 155, 00166 Rome, Italy.
Federico
F
Lo Torto
Tissue Engineering Unit, Department of Engineering, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, 00128 Rome, Italy.
Sara M
SM
Giannitelli
Surface Analysis Laboratory, Department of Mathematics and Physics, University "Roma Tre", Via della Vasca Navale 84, 00146 Rome, Italy; INFN - National Institute of Nuclear Physics, Section of Roma Tre, Via della Vasca Navale 84, 00146 Rome, Italy.
Marco
M
Urbini
Surface Analysis Laboratory, Department of Mathematics and Physics, University "Roma Tre", Via della Vasca Navale 84, 00146 Rome, Italy; INFN - National Institute of Nuclear Physics, Section of Roma Tre, Via della Vasca Navale 84, 00146 Rome, Italy.
Luca
L
Tortora
Tissue Engineering Unit, Department of Engineering, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, 00128 Rome, Italy.
Pamela
P
Mozetic
Tissue Engineering Unit, Department of Engineering, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, 00128 Rome, Italy.
Marcella
M
Trombetta
Department of Chemical Science and Technologies, University of Rome "Tor Vergata", Via della Ricerca Scientifica 1, 00173 Rome, Italy.
Francesco
F
Basoli
Department of Chemical Science and Technologies, University of Rome "Tor Vergata", Via della Ricerca Scientifica 1, 00173 Rome, Italy.
Silvia
S
Licoccia
Department of Radiation Oncology, "Sapienza" University of Rome, Viale del Policlinico 155, 00166 Rome, Italy; Spencer-Lorillard Foundation, Viale Regina Elena 291, 00161 Rome, Italy.
Vincenzo
V
Tombolini
Department of Radiation Oncology, "Sapienza" University of Rome, Viale del Policlinico 155, 00166 Rome, Italy.
Raffaele
R
Cassese
Department of Plastic Surgery, "Sapienza" University of Rome, Viale del Policlinico 155, 00166 Rome, Italy.
Nicolò
N
Scuderi
Tissue Engineering Unit, Department of Engineering, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, 00128 Rome, Italy; IFN - Institute for Photonics and Nanotechnologies, National Research Council, Via Cineto Romano 42, 00156 Rome, Italy. Electronic address: a.rainer@unicampus.it.
Alberto
A
Rainer
D018427:Breast Implants; D019245:Compressive Strength / Q000528:radiation effects; D004307:Dose-Response Relationship, Radiation; D055119:Elastic Modulus / Q000187:drug effects; D004867:Equipment Design; D019544:Equipment Failure Analysis; D006244:Hardness / Q000528:radiation effects; D008408:Mastectomy; D008422:Materials Testing; D011182:Postoperative Care; D011829:Radiation Dosage; D018714:Radiotherapy, Adjuvant; D012826:Silicone Elastomers / Q000737:chemistry* / Q000528:radiation effects*; D013718:Tensile Strength / Q000528:radiation effects
D012826:Silicone Elastomers
Capsular contracture; Post-mastectomy radiation therapy (PMRT); Silicone breast implants; Surface analyses