by Danino, Michel A.; El Khatib, Arij M.; Doucet, Ophélie;
Dao, Lan; Efanov, Johnny I.; Bou-Merhi, Joseph S.; Iliescu-Nelea, Monica
Summary:
Acellular dermal matrices have become a mandatory tool in reconstructive breast
surgery. Since their introduction, they have been considered to be nonreactive
and nonimmunogenic scaffolds. However, some patients who undergo implant-based
breast reconstruction with acellular dermal matrices develop postoperative
cutaneous erythema overlying their matrices, a condition commonly referred to
as red breast syndrome. The aim of this study was to gain a better understanding
of this phenomenon. An analysis was conducted on consecutive patients who
underwent acellular dermal matrix– and implant-based breast reconstructions and
developed red breast syndrome that was treated surgically between April of 2017
and June of 2018 at the authors’ institution. During surgery, 1-cm2 specimens
of acellular dermal matrix were sampled and analyzed by scanning electron
microscopy. Observations were charted to score and record the presence and
thickness of biofilm, and for identification of bacteria. These measurements
were performed using Adobe Photoshop CS6 Extended software. Six postmastectomy
breast reconstruction patients were included, all with AlloDerm
Ready-to-Use–based reconstructions. All specimens were colonized by various
bacteria ranging from Gram-negative bacilli to Gram-positive microorganisms.
Biofilm was present in all studied specimens. The cause of skin erythema
overlying acellular dermal matrix grafts, and the so-called red breast
syndrome, may be related to contamination with various bacteria. Although
contamination was omnipresent in analyzed samples, its clinical significance is
variable. Even if acellular dermal matrix–based reconstructions are salvaged,
this could come at the price of chronic local inflammation.
