Impact of Chemotherapy and Radiation Therapy on Inflammatory Response, Neovascularization, and Capsule Formation of Acellular Dermal Matrix in Breast Reconstruction: Analysis of the BREASTrial Biopsy Specimens

Abstract

Background: The Breast Reconstruction Evaluation of Acellular Dermal Matrix as a Sling Trial is a single-center, blinded, prospective, randomized, controlled trial established to compare outcomes using two popular types of acellular dermal matrices, AlloDerm and DermaMatrix, in tissue expander breast reconstruction. This study used the acellular dermal matrix biopsy specimens from the trial to evaluate how adjuvant therapy influences inflammation, neovascularization, and capsule formation of the acellular dermal matrix. Methods: Punch biopsy specimens were taken at the time of expander exchange and were analyzed by a blinded pathologist. The inflammatory response was quantified by the number of fibroblasts, giant cells, and lymphocytes. Neovascularization and capsule formation were similarly quantified by the number of new capillaries and capsule presence and thickness, respectively. Results: Histology specimens were collected from 109 patients (170 breasts). In the absence of adjuvant therapy, there was no significant difference between AlloDerm and DermaMatrix in terms of inflammation, neovascularization, or capsule thickness. Both acellular dermal matrices showed a significant decrease in inflammation and neovascularization with adjuvant therapy. When chemotherapy and radiation therapy were used, the decrease in inflammation was greatest for the group reconstructed with DermaMatrix (p < 0.039). Conclusions: Adjuvant therapy influences the inflammatory response, neovascularization, and capsule formation in both acellular dermal matrices. Adjuvant therapy has a protective effect on the inflammatory response toward both acellular dermal matrices in breast reconstruction. In the setting of chemotherapy and radiation therapy, DermaMatrix produced the greatest reduction in inflammation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

The BREASTrial Stage III: Acellular Dermal Matrix Breast Reconstruction Outcomes from Three Months to Two Years Postoperative

“…1,2 Supporting this potential limitation are the histologic results from the BREASTrial biopsy specimens, which showed that groups of patients who underwent reconstruction with DermaMatrix experienced less of an inflammatory response compared to those who underwent reconstruction with AlloDerm. 6 Obesity was a reliable predictor of developing a complication, regardless of acellular dermal matrix type or reconstruction method. This finding is consistent with findings from stage II.…”

“…This trial specifically supports two-stage reconstruction as a safe approach, as the overall complication rates were low among our cohort and histologic results were similar between acellular dermal matrices. 6 Ultimately, patient preference and surgeon expertise should be used during preoperative planning, as both approaches have benefits and drawbacks.…”

“…1,2 Supporting this potential limitation are the histologic results from the BREASTrial biopsy specimens, which showed that groups of patients who underwent reconstruction with DermaMatrix experienced less of an inflammatory response compared to those who underwent reconstruction with AlloDerm. 6…”

A Two-Year Retrospective Analysis of the Clinical Outcomes of Immediate Submuscular Breast Reconstructions With Native® Acellular Dermal Matrix

“…However, although the submuscular ADM-assisted technique is now extensively documented, the choice of reconstruction materials should always be evaluated, updating clinical practice with increasingly extensive follow-ups. Furthermore, in the current broad panorama of reconstruction-declined devices, different materials may lead to different outcomes: source, preparation, and thickness of acellular dermal matrices may influence the development of post-operative complications [ 25 ]. Therefore, each device should be investigated individually and independently.…”

Discussion: A Comparative Study of Wraparound versus Anterior Coverage Placement of Acellular Dermal Matrix in Prepectoral Breast Reconstruction

“…Why is the capsular contracture rate the same for complete implant ADM coverage versus only anterior coverage as seen in the authors' study, and what is the histologic difference of capsule formation on pectoralis fascia versus ADM? Although ADM does seem to mitigate some of the effects of postoperative radiation therapy as the authors note, [15][16][17][18] can we develop additional techniques in addition to fat grafting 19,20 to further modify the effects of radiation therapy? Does complete wraparound coverage give better protection from radiation than just anterior coverage?…”