The use of acellular dermal matrix in immediate two-stage prosthetic breast reconstruction provides protection from postmastectomy radiation therapy: a clinicopathologic perspective

  • Tae Hwan Park
  • Soon Won Chung
  • Seung Yong Song
  • Dae Hyun Lew
  • Tai Suk Roh
  • Dong Won Lee
Clinical Applications of Biomaterials Clinical Investigation
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  1. Clinical Applications of Biomaterials

Abstract

Although there is ample evidence showing that radiation therapy increases the risk of complications of breast reconstruction, the efficacy of human acellular dermal matrix (CGCryoDerm®) in immediate tissue expander breast reconstruction in the setting of postmastectomy radiation therapy has not been fully elucidated. In this study, we report our institutional experience with pertinent refined surgical technique, and determine whether acellular dermal matrices have a protective effect in this increasingly prevalent clinical setting. Twenty-six patients who underwent immediate two-stage breast reconstruction in the setting of postmastectomy radiation therapy with at least 2 years of follow-up were retrieved. Fifteen patents were reconstructed with ADM, whereas 11 patients were reconstructed without ADM. The occurrence of complications was assessed according to the reconstruction type (with ADM vs without ADM). Furthermore, in patients reconstructed with ADM (n = 15), immunohistochemistry was performed to analyze the breast capsule with ADM compared with that without ADM in the same patient, according to the expression of alpha-smooth muscle actin (α-SMA). The occurrence of complications was significantly associated with the reconstruction type (with ADM vs. without ADM, p = 0.015). On the basis of the results of α-SMA staining, α-SMA+ myofibroblasts were relatively highly expressed throughout the breast capsule without ADM. On the contrary, α-SMA+ myofibroblasts present at the breast capsule adjacent to the ADM were scarce and irregularly scattered. Use of an acellular dermal matrix may be recommended to patients who are concerned about complications after immediate two-stage breast reconstruction in the setting of postmastectomy radiation therapy.

Abbreviations

postmastectomy radiation therapy

(PMRT)

Immediate tissue expander/implant breast reconstruction

(ITEIBR)

acellular dermal matrix

(ADM)

Tissue expander

(TE)

Tissue expander/Implant

(TE/I)

Alpha-smooth muscle actin

(α-SMA)

Masson trichrome

(MT)

Notes

Funding

This study was supported by research grants from CGBio. The funder had no role in study design, data collection and analysis, the decision to publish, or the preparation of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Tae Hwan Park
    • 1
  • Soon Won Chung
    • 2
  • Seung Yong Song
    • 2
  • Dae Hyun Lew
    • 2
  • Tai Suk Roh
    • 2
  • Dong Won Lee
    • 2
  1. 1.Department of Plastic and Reconstructive Surgery, CHA Bundang Medical CenterCHA UniversitySeongnamRepublic of Korea
  2. 2.Institute for Human Tissue Restoration, Department of Plastic and Reconstructive SurgeryYonsei University College of MedicineSeoulRepublic of Korea

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