Plastic Surgery Research Council
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PSRC 60th Annual Meeting

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Comparison of the Histological Characteristics of ADM Capsules to No-ADM Breast Capsules in ADM-Assisted Breast Reconstruction
Deborah Yu, MD, Kasandra Hanna, MD, Robin LeGallo, MD, David Drake, MD.
University of Virginia, Charlottesville, VA, USA.

INTRODUCTION: Acellular dermal matrices (ADM) have been proposed to have several advantages in implant-based breast reconstruction over traditional techniques. The goal of this study was to compare histological characteristics between areas of the capsule containing a novel decellularized regenerative matrix and areas without the ADM in ADM-assisted breast reconstruction.
METHODS: Women undergoing implant-based breast reconstruction at the University of Virginia Health System using a Matracell™ decellularized regenerative matrix were enrolled in this IRB-approved study. Forty-eight non-ADM and ADM breast capsule biopsy specimens were collected from fifteen women and analyzed for several histological parameters: inflammation, vascular proliferation, capsule fibrosis, foreign body giant cell inflammatory reaction, and myofibroblasts. A semi-quantitative scoring system was used for evaluation. The presence or absence of an inflammatory capsule and of suture granulomas were also assessed. The evaluator of the specimens was blinded to the tissue source.
RESULTS: There was significantly less inflammation in the ADM capsule biopsy samples compared with the no-ADM capsule biopsy samples (ADM: 0.83±0.70; no-ADM 1.83±0.82; p<0.001). There was significantly less fibrosis in the ADM samples (ADM: 0.92±0.58; no-ADM: 1.29±0.62; p=0.037). There was a significantly higher likelihood of presence of an inflammatory capsule in the no-ADM biopsy samples (p=0.005). There were significantly less myofibroblasts in the ADM group (ADM: 0.79±0.66; no-ADM: 1.46±0.51; p<0.001). There was significantly less vascular proliferation in the ADM samples compared with the no-ADM samples (ADM: 0.75±0.61; no-ADM: 1.42±0.58; p<0.001). There were no significant differences in the amount of giant cell reaction (ADM: 0.50±0.83; no -ADM: 1.00±1.10; p=0.083) or the presence of suture granuloma (p=0.128).
CONCLUSION: When used for staged breast reconstruction, this novel decellularized regenerative matrix processed using Matracell™ technology appears to induce less inflammation and less myofibroblasts. These results may explain the observed decreased capsular contracture in ADM-assisted breast reconstruction.
Table 1. Difference in cellular characteristics among ADM capsule biopsy samples and no-ADM capsule biopsy samples.
ADM
(n=24)
No-ADM capsule
(n=24)
P
Inflammation0.831.83<0.001*
Vascular Proliferation0.751.42<0.001*
Giant Cell0.501.000.083
Fibrosis0.921.290.037*
Inflammatory Capsule0.130.500.005*
Suture Granuloma0.250.080.128
Myofibroblast0.791.46<0.001*

*Significant difference in multiple characteristics between no-ADM and ADM-associated capsules.


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