Background: Acellular cadaveric dermis in implant-based breast reconstruction provides an alternative to total submuscular placement. To date, there has been no detailed in vivo human analysis of the histopathologic sequelae of acellular cadaveric dermis in implant-based breast reconstruction. Based on clinical observations, we hypothesize that acellular cadaveric dermis decreases the inflammatory response and foreign body reaction normally seen around breast implants.
Methods: Twenty patients underwent tissue expander reconstruction using the “dual-plane” acellular cadaveric dermis technique (AlloDerm). During implant exchange, intraoperative biopsy specimens were obtained of (1) biointegrated acellular cadaveric dermis and (2) native subpectoral capsule (internal control). Histopathologic analysis was performed. Masked biopsy specimens were scored semiquantitatively by an experienced histopathologist to reflect observed granulation tissue formation, vessel proliferation, chronic inflammatory changes, capsule fibrosis, fibroblast cellularity, and foreign body giant cell inflammatory reaction. Scores were analyzed statistically using the Wilcoxon signed rank test.
Results: Acellular cadaveric dermis (AlloDerm) had statistically diminished levels for all parameters compared with corresponding native breast capsules (p < 0.001).
Conclusions: This represents the first detailed histopathologic comparative analysis between biointegrated acellular cadaveric dermis and native capsules in implant-based breast reconstruction. These histopathologic findings suggest that certain properties intrinsic to acellular cadaveric dermis may limit capsule formation by diminishing inflammatory changes that initiate capsule formation. Further investigation is needed to determine whether acellular cadaveric dermis reduces the incidence of breast capsular contracture.
From the Institute of Advanced Breast Reconstruction; the Section of Plastic Surgery, Michael E. DeBakey Veterans Affairs Medical Center; and the Department of Pathology, Baylor College of Medicine.
Received for publication November 2, 2009; accepted May 20, 2010.
Presented at Plastic Surgery 2009, the Annual Meeting of the American Society of Plastic Surgeons, in Seattle, Washington, October 25, 2009.
Disclosures: Dr. Basu serves on the speakers bureau for LifeCell Corp., and received research grant funding from LifeCell for consumables for this project. Neither of the other authors has any additional disclosures.
C. Bob Basu, M.D., M.P.H., Institute of Advanced Breast Reconstruction, 6400 Fannin, Suite 2100, Houston, Texas 77030, firstname.lastname@example.org