Publication date: Available online 22 May 2019
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Ara Kim, Jae Hoon Jung, Yoon-La Choi, Jai-Kyong PyonSUMMARY
Capsular contracture is a common complication in implant-based breast surgery. To prevent capsular contracture, high-risk patients can be identified and triaged before undergoing medical prevention.
Acellular dermal matrix (ADM) capsule biopsy was performed to predict future capsular contracture in patients undergoing two-stage ADM-based prosthetic breast reconstruction.
A prospective pilot clinical trial with ten consecutive patients from November 2013 to October 2015 was conducted. Full-thickness biopsy specimens were obtained from both the ADM lining capsule and the native subpectoral capsule (internal control) during expander-implant exchange. Capsule specimens were scored for the presence of fibrosis and inflammation. Six months after expander-implant exchange, capsular contracture was clinically assessed using Baker's grade. Statistical correlation was determined between the total sum of the histopathologic scores of capsule and Baker's grade.
After exclusion criteria were applied, four out of seven patients developed mild capsular contracture (Baker's grade 2) at 6-month postoperative follow-up. The ADM capsule histopathologic score showed a strong positive correlation with postoperative 6-month Baker's grade, while subpectoral capsule score showed no significant correlation with Baker's grade.
High level of ADM capsule fibrosis and inflammation may be warning signs of future clinical capsular contracture. Simultaneous ADM capsule biopsy during expander-implant exchange in ADM-based breast reconstruction can be a safe and efficient strategy to predict future capsular contracture.