Effect of adipose-derived stem cells on acellular dermal matrix engraftment in a rabbit model of breast reconstruction.

Acellular dermal matrix (ADM) is frequently used in implant-based breast reconstruction. Although there are several advantages, ADM implantation also increases the risk of certain complications. Recently, ADM seeded with adipose-derived stem cells (ADSCs) were shown to induce angiogenesis and improve wound healing. This study aimed to investigate the effects of ADSCs on ADM engraftment in a rabbit model of implant-based breast reconstruction. Silicone implants were inserted to submuscular pocket of 16 female New Zealand rabbits using ADM with or without seeding of fluorescent PKH26-labelled rabbit ADSCs. The marginal and central ADMs in each group were evaluated at 1 and 3 months after insertion. We performed a histological analysis including the number of CD31 blood vessels, vimentin fibroblasts and lymphocytes; live/dead analysis; and gene expression analysis related to angiogenesis, inflammation and hypoxia. The implant was exposed in one rabbit with ADM without ADSCs during the study period. At 1 month, a histological analysis revealed more blood vessels and fibroblasts and reduced immune cell infiltration in marginal ADM with ADSCs. At 3 months, only angiogenesis was histologically different between groups. Conversely, cellularity was not significantly different in the central ADM between groups at month 1 or 3. ADSC supplementation increased the gene expression level associated with angiogenesis and inflammation, but not hypoxia. PKH26-labelled ADSCs were observed in both marginal and central ADMs at month 3. ADM seeded with ADSCs might be useful in promoting early incorporation with recipient tissue. This study supports the potential of ADM seeded with ADSCs as a reliable material for implant-based breast reconstruction.