Publication date: Available online 14 May 2019
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): I. Ludolph, J.S. Gruener, A. Weigand, C. Fiessler, R.E. Horch, M. Schmitz
Summary
Acellular dermal matrices have recently increasingly been used in alloplastic breast reconstruction with silicone breast implants. Among these, acellular porcine dermis (APD) is frequently applied, but long-term data on tissue integration and capsular fibrosis formation are still missing.
Silicone prostheses with (group A) and without (group B) APD as an implant covering shell were implanted in male Lewis rats. At 3, 12, and 52 weeks after implantation, the constructs were explanted. Molecular biological and immunohistochemical analysis was performed afterwards.
Comparing the collagenous layer and the newly formed myofibroblast-rich layer around the implants of both groups, it became apparent that in group A with APD these layers were thinner, going along with a lower expression of TGFβ1 after 12 and 52 weeks. At the endpoint of 52 weeks, in this group a lower amount of CD68 positive cells in the collagenous and myofibroblast-rich layer was counted and the expression of TNFα was reduced, while the number of Ki67-positive cells was significantly higher over time. Furthermore, MMP1 expression was lower compared to group B without APD, and the calculated ratio of MMP1:TIMP1 expression was higher.
The long-term results clearly show a reduction of inflammatory and fibrotic tissue reaction when APD is used to cover silicone prostheses. These experimental data will be of great importance for implant-based breast surgery, since they indicate a potential benefit in the reduction of capsular fibrosis formation of an interposition of APD between the recipient and the silicone implant.
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