by Mendenhall, Shaun D.; Graham, Emily M.; Anderson,
Layla A.; Ying, Jian; Liu, Ting; Agarwal, Jayant P.
Plastic and Reconstructive Surgery: March 2022 -
Volume 149 - Issue 3 - p 378e-385e
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.
