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 (ADM) used in prosthetic breast reconstruction will typically incorporate, in time, with the overlying mastectomy skin flap. This remodeling process may be adversely impacted in patients that require chemotherapy and radiation therapies that influence neovascularization and cellular proliferation. Methods Multiple biopsies of the submuscular capsule and ADM 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 ADM. Specimens were assessed grossly for incorporation and semi-quantitatively for cellular infiltration, cell type, fibrous encapsulation, scaffold degradation, extracellular matrix deposition, neovascularization, mean composite remodeling score, as well as Type I and III collagen area and ratio. Five oncologic treatment groups were compared : no adjuvant therapy (untreated), neoadjuvant chemotherapy ± radiation ; and chemotherapy ± radiation. Results ADM and submuscular capsule biopsies were procured 45 to 1805 days after ADM insertion and demonstrated a significant reduction in Type I collagen over time. Chemotherapy adversely impacted fibrous encapsulation relative to the untreated group (p=0.03). Chemotherapy with or without radiation adversely impacted Type I collagen area (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 gross incorporation as well as 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 ADM remodeling.

Evaluation of Complication Rates after Breast Surgery Using Acellular Dermal Matrix: Median Follow-Up of Three Years

“…Furthermore, it has already been shown that radio- or chemotherapy had an influence on implanted ADMs (Alloderm), resulting in a limited ADM modeling [20]. …”

Volume replacement with diced acellular dermal matrix in oncoplastic breast-conserving surgery: a prospective single-center experience

“…After AMD implantation, neovascularization occurs between 1 and 6 months postoperatively [7]. During this period, most patients undergo chemo-and/ or RT, which has already been shown to limit ADM remodeling [19]. In our study, 45.8% of all complications occurred between 2 weeks and 6 months.…”

Assessment and planning for oncoplastic and reconstructive breast surgery: a review and a proposed chart

“…However, the severity of capsular contracture rate is reportedly less with acellular dermal matrix (ADM) [5] reflecting some animal studies [6,7]. Chemotherapy independently can adversely affect the type 1 collagen thereby affecting the remodelling and integration of ADM [8].…”