Abstract:The use of AlloDerm to partially enclose implants effectively prevented formation of a capsule in areas where AlloDerm contacted the implant at 10 weeks. Long-term studies will be required to determine whether this is a durable result that can be reproduced in humans.
“…In contrast, ADM-assisted reconstructions have consistently been associated with CC rates of <5%, albeit a shorter follow-up period of 0.6-2.4-year (9-15) is reported. Mechanistic studies in animal models as well as human histopathologic studies suggest a reduction or delay in capsule formation in the presence of ADM as a possible explanation for the reduced occurrence of CC (5,(16)(17)(18).…”
Section: Introductionmentioning
confidence: 99%
“…Although originally intended to provide support and coverage of the breast lower pole, growing evidence suggests that ADM use may also mitigate the risk of capsular contracture (CC) (2)(3)(4)(5).…”
Background: Irradiation of implant-based breast reconstructions (BR) is known to increase capsular contracture (CC) rates on average by 4-fold over non-irradiated reconstructions. The use of acellular dermal matrix (ADM) has been associated with lower CC rates in non-irradiated reconstructions (0-3%).Experimental and clinical studies suggest that ADM may also reduce CC rates in irradiated breasts. The aim of this study was to evaluate CC rates in non-irradiated and irradiated one-and two-stage BRs performed with the assistance of porcine ADM (PADM).Methods: A single centre, retrospective, cohort study was designed from December 2008 to October 2012.A total of 200 immediate implant-based BRs were performed using PADM for inferior pole reinforcement.We included non-irradiated BR with a minimum follow up of 6 month from primary surgery (one stage) or from explantation of expander and implantation of the definitive implant (two stage). Of the postoperatively irradiated BR we included patients with 1 year or more follow up time from termination of radiotherapy.CC was graded using the conventional Spear-Baker classification and modified version for irradiated BR.According to the literature Grade III and IV CC were defined as clinically significant CC.
Results: Of 200 BRs with PADM, 122 were included in this study (84 non-irradiated and 38 irradiated).Sixty-five BR were one stage and 57 were two stage BR. Grade III/IV CC was remarkable low in nonirradiated (6%) and irradiated BR (13%). There was a non-significant trend to increased Grade III and IV CC in irradiated BR vs. non-irradiated BR (13% vs. 6%, P=0.216). In this study follow up time (P<0.001) and the stage of ADM reconstruction (two vs. one stage, P=0.022) were significant risk factors for occurrence of grade III/IV CC on univariate analysis and remained significant for the follow up time (P=0.013) and remarkable for the stages (P=0.093) in multivariate analysis.
Conclusions:Our data support the current clinical evidence that ADM use in implant-based BR is associated with a reduced risk of CC when compared to the standard submuscular techniques in literature.The reduced risk is maintained in the setting of radiotherapy. Two stage procedures in our study population showed increased grade III/IV CC compared to one stage procedures with or without exposure to radiation.
“…In contrast, ADM-assisted reconstructions have consistently been associated with CC rates of <5%, albeit a shorter follow-up period of 0.6-2.4-year (9-15) is reported. Mechanistic studies in animal models as well as human histopathologic studies suggest a reduction or delay in capsule formation in the presence of ADM as a possible explanation for the reduced occurrence of CC (5,(16)(17)(18).…”
Section: Introductionmentioning
confidence: 99%
“…Although originally intended to provide support and coverage of the breast lower pole, growing evidence suggests that ADM use may also mitigate the risk of capsular contracture (CC) (2)(3)(4)(5).…”
Background: Irradiation of implant-based breast reconstructions (BR) is known to increase capsular contracture (CC) rates on average by 4-fold over non-irradiated reconstructions. The use of acellular dermal matrix (ADM) has been associated with lower CC rates in non-irradiated reconstructions (0-3%).Experimental and clinical studies suggest that ADM may also reduce CC rates in irradiated breasts. The aim of this study was to evaluate CC rates in non-irradiated and irradiated one-and two-stage BRs performed with the assistance of porcine ADM (PADM).Methods: A single centre, retrospective, cohort study was designed from December 2008 to October 2012.A total of 200 immediate implant-based BRs were performed using PADM for inferior pole reinforcement.We included non-irradiated BR with a minimum follow up of 6 month from primary surgery (one stage) or from explantation of expander and implantation of the definitive implant (two stage). Of the postoperatively irradiated BR we included patients with 1 year or more follow up time from termination of radiotherapy.CC was graded using the conventional Spear-Baker classification and modified version for irradiated BR.According to the literature Grade III and IV CC were defined as clinically significant CC.
Results: Of 200 BRs with PADM, 122 were included in this study (84 non-irradiated and 38 irradiated).Sixty-five BR were one stage and 57 were two stage BR. Grade III/IV CC was remarkable low in nonirradiated (6%) and irradiated BR (13%). There was a non-significant trend to increased Grade III and IV CC in irradiated BR vs. non-irradiated BR (13% vs. 6%, P=0.216). In this study follow up time (P<0.001) and the stage of ADM reconstruction (two vs. one stage, P=0.022) were significant risk factors for occurrence of grade III/IV CC on univariate analysis and remained significant for the follow up time (P=0.013) and remarkable for the stages (P=0.093) in multivariate analysis.
Conclusions:Our data support the current clinical evidence that ADM use in implant-based BR is associated with a reduced risk of CC when compared to the standard submuscular techniques in literature.The reduced risk is maintained in the setting of radiotherapy. Two stage procedures in our study population showed increased grade III/IV CC compared to one stage procedures with or without exposure to radiation.
“…The immunologically inert nature of ADMs has been suggested to confer a protective effect against capsule formation, fibrosis, and contraction by minimizing this inflammatory cascade. [19][20][21] To date in our series, capsular contracture has not been problematic. A low incidence of capsular contracture was also reported in the other recent studies of prepectoral implant-based reconstruction with total ADM coverage.…”
“…In ADM-assisted implant-based primary reconstructions, a low rate of capsular contracture (0%-2%) has been observed (S. Becker et al, 2009;Bindingnavele et al, 2007;Breuing & Colwell, 2007;Namnoum, 2009;Salzberg, 2006;Salzberg et al, 2011;Spear et al, 2008;Zienowicz & Karacaoglu, 2007), suggesting that ADMs may help prevent or reduce the risk of capsular contracture; hence, the rationale for using ADMs for the correction and prevention of capsular contracture. Animal and clinical studies suggest that ADMs may prevent capsular contracture by minimizing the inflammatory response, thereby reducing capsule formation around implants (Basu et al, 2010;Komorowska-Timek et al, 2009;Orenstein et al, 2010;Stump et al, 2009;Uzunismail et al, 2008). Published series have reported successful correction of > 90% of grade 3/4 capsular contractures with the use of ADMs with no recurrences during a mean follow-up period of 9-21 months (Breuing & Colwell;Hartzell et al, 2010;Spear et al, 2011).…”
Section: Correction Of Capsular Contracturementioning
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