title: Acellular dermal matrix reduces capsule formation in two-stage breast reconstruction.
abstract: Acellular dermal matrix (ADM) is commonly employed to create an inferior pocket for the tissue expander in two-stage breast reconstruction. The authors sought to determine whether placement of ADM during the first stage of reconstruction decreases the amount of capsule formation at implant exchange. Patients who underwent mastectomy and tissue expander reconstruction were included in this study. Two biopsies were obtained at the time of implant exchange, one from the pocket adjacent to the ADM and the other from the area adjacent to the pectoralis muscle. Pathology analysis was performed on each sample. Ten patients underwent immediate breast reconstruction with Alloderm during the 3-month study period. Capsule thickness was significantly greater in the areas where the expander was in direct contact with the pectoralis muscle (782 ± 194 µm) compared to those in contact with human acellular dermal matrix (hADM) (47·91 ± 110·82 µm; P < 0·05). Analysis of the sub-pectoral capsule demonstrated diffuse deposition of collagen, neutrophils, contractile myofibroblasts and synovia-like metaplasia, characteristic of a foreign body response. Conversely, within the inferior pocket where the hADM was in direct contact with the expander, we noted migration of host epithelial cells, fibroblasts, mesenchymal cells and angiogenesis, indicating host tissue regeneration. Acellular dermal matrix, when placed at the first stage of breast reconstruction, significantly reduces thickness and inflammatory character of the capsule in comparison to the patient's native tissue.
authors.affiliation: Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.|Department of Plastic & Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Karan
authors.initials: K
authors.lastname: Chopra
authors.affiliation: Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Buckingham
authors.affiliation: Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Jamil
authors.initials: J
authors.lastname: Matthews
authors.affiliation: Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Sabino
authors.affiliation: Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Kashyap K
authors.initials: KK
authors.lastname: Tadisina
authors.affiliation: Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Silverman
authors.affiliation: Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Nelson H
authors.initials: NH
authors.lastname: Goldberg
authors.affiliation: Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Sheri
authors.initials: S
authors.lastname: Slezak
authors.affiliation: Department of Plastic Surgery, Anne Arundel Medical Center, Annapolis, MD, USA.
authors.forename: Devinder P
authors.initials: DP
authors.lastname: Singh
mesh_terms: D062088:Acellular Dermis; D000328:Adult; D018427:Breast Implants; D001943:Breast Neoplasms / Q000534:rehabilitation* / Q000601:surgery*; D003094:Collagen / Q000009:adverse effects*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D013997:Time Factors; D015625:Tissue Expansion Devices; D014945:Wound Healing
chemical_list: D003094:Collagen
keywords: Capsule formation; Human acellular dermal matrix; Two-stage breast reconstruction