BREAST SURGERY

Further Evidence that Human Acellular Dermal Matrix Decreases Inflammatory Markers of Capsule Formation in Implant-Based Breast Reconstruction.

By January 15, 2018 No Comments

Mimi Leong, MD, MS, FACS C. Bob Basu, MD, MPH, FACS M. John Hicks, MD, DDS, PhD

Aesthetic Surgery Journal, Volume 35, Issue 1, 1 January 2015, Pages 40–47

Published: 07 January 2015

Abstract
Background

Human acellular dermal matrix (HADM; previously termed “acellular cadaveric dermis”) may limit inflammatory changes believed to play a role in capsular contracture, a common complication of implant-based breast reconstruction.

Objectives

Differences between HADM and native breast capsule specimens were evaluated by immunohistochemical analysis of key inflammatory markers involved in capsule formation.

Methods

Twenty consecutive patients underwent immediate, 2-stage, implant-based breast reconstruction with dual-plane HADM. During tissue expander–implant exchange, full-thickness biopsies of biointegrated HADM and native breast capsule (internal control) from the tissue-expander envelope were obtained. Immunohistochemical analysis was performed for endothelial cells (CD31), B cells (CD20), T cells (CD3), macrophages (CD68), collagen I and III, and myofibroblasts (α-smooth muscle actin). Observed Levels of marker labeling were semiquantitatively scored from 0 (none) to 3 (severe) by a blinded histopathologist and were statistically analyzed with the Wilcoxon rank sum test.

Results

A bilateral sample was obtained from 1 patient; all other samples were unilateral. Compared with capsule samples from native breast tissue, HADM samples had significantly lower Levels of all inflammatory markers (P < .001).

Conclusions

These lower Levels of inflammatory markers support previous evidence that HADM may inhibit inflammatory and profibrotic signaling characteristics of breast capsule development and decrease the risk of capsular contracture. Further investigation is needed to determine the mechanism by which HADM inhibits these inflammatory cells, whether HADM reduces the incidence of breast capsular contracture, and if so, the longevity of this effect.

Level of Evidence: 3

Patient-Reported Quality-of-Life Outcomes of Breast Reduction Evaluated with Generic Questionnaires and the Breast Reduction Assessed Severity Scale.

Yavuz Kececi, MD Emin Sir, MD Melike Gungor, MD

Aesthetic Surgery Journal, Volume 35, Issue 1, 1 January 2015, Pages 48–54

Published: 07 January 2015

Abstract
Background

The effects of breast reduction on quality of life (QOL) have been evaluated in patients with macromastia, but few investigators have performed condition-specific assessments.

Objectives

The authors employed generic and condition-specific questionnaires to examine the QOL of patients with macromastia and determined the responsiveness of the Turkish version of Breast Reduction Assessed Severity Scale (BRASS).

Methods

This prospective cohort study included patients with breast hypertrophy who underwent breast reduction (n = 94). Patients completed the Turkish versions of the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), the BRASS, and the Rosenberg Self-Esteem Scale preoperatively and 4 months postoperatively. Differences in responses were evaluated by paired t-test and by comparing change effect sizes. Multiple regression analyses were performed to evaluate improvements in QOL in response to adjustments in baseline differences across patients.

Results

Preoperative and postoperative questionnaires were completed by 78 patients (83%). Significant postoperative improvements in self-esteem (Rosenberg Self-Esteem Scale; P < .001) and in all domains of the BRASS (P < .001) were noted. Mean preoperative scores for 5 of 8 domains in the SF-36 were lower than those of a normative population. Postoperatively, all 5 mean scores improved significantly, but the score for bodily pain remained less than that of a normative population.

Conclusions

The results of this study indicate significant improvements in health-related QOL at 4 months after breast reduction in a population of patients with macromastia. The authors also demonstrate excellent responsiveness of the BRASS.

Level of Evidence: 3