Influence of Irradiation on Capsules of Silicone Implants Covered with Acellular Dermal Matrix in Mice

• Published in: Aesthetic plastic surgery Vol. 46; no. 2; pp. 937 - 946
• Main Authors: Lee, Joon Seok, Lee, Jung Ho, Ryu, Jeong Yeop, Park, Shin-Hyung, Park, Ji-Young, Han, Man-Hoon, Lee, Jeeyeon, Park, Ho Yong, Yang, Jung Dug
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.04.2022; Springer Nature B.V
• Subjects: Acellular Dermis - radiation effects; Animals; Breast cancer; Breast Implants; Capsules; Evidence-based medicine; Humans; Implant Capsular Contracture - etiology; Implant Capsular Contracture - prevention & control; Mammaplasty; Medicine; Medicine & Public Health; Mice; Original Article; Otorhinolaryngology; Plastic Surgery; Radiation therapy; Radiotherapy - adverse effects; Silicones; Skin & tissue grafts; Surgery; Transforming Growth Factor beta1; Transplants & implants; Breast implant; Acellular dermal matrix; Capsular contracture; Radiotherapy; Breast reconstruction; Pseudoepithelium
• ISSN: 0364-216X; 1432-5241
• DOI: 10.1007/s00266-021-02618-4

Background In advanced breast cancer, radiotherapy is recommended as adjuvant therapy following breast reconstructive surgery. This inevitably led to growing concerns over possible complications of radiotherapy on implants. In this experimental animal study, we investigated the utility of acellular dermal matrix (ADM) wraps around implants as preventive management for radiotherapy complications. Methods Black mice (C57NL6; n  = 32) were assigned to groups that either received radiation or did not: groups A and B underwent surgery using implants without radiotherapy; while groups C and D underwent surgery using implants with radiotherapy for one and three months, respectively. The hemispheric silicone implants with an 0.8-cm-diameter were inserted on the left back of each mouse, and implants wrapped by ADM were inserted on the right back. The Clinic 23EX LINAC model was used for irradiation at 10 Gy. The samples were evaluated by gross assessment, histological analysis, immunohistochemical analysis, and the Western blotting test. Results The H&E staining analysis showed that membrane thickness is smallest in group A , followed by groups C , D , and B . In a Masson trichrome histological analysis, collagen fibers became less dense and more widespread over time in the groups that received an ADM. Immunohistochemistry findings were similarly constant. However, the expression of TGF- β 1 was increased in the irradiated groups, whereas it was decreased in the non-irradiated groups as observed over time. Conclusions Radiotherapy was shown to increase risk factors for capsular contracture, including inflammatory response, pseudoepithelium, thinning of membrane, and TGF- β 1 expression over time; however, the accompanying framework using an ADM as a barrier between implant and tissue was shown to be effective in alleviating these risks. No Level Assigned This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .