From the Division of Plastic and Reconstructive Surgery and Department of Pathology, Northwestern Memorial Hospital; and Northwestern University Feinberg School of Medicine.
Plast Reconstr Surg. 2021 Nov 1;148(5):968-977. doi: 10.1097/PRS.0000000000008485.
Capsular contracture is a well-recognized complication following prosthetic breast reconstruction. It has been the authors' observation that some patients undergoing breast reconstruction experience contracture specifically of the acellular dermal matrix placed at the time of their tissue expander insertion. The goal of the authors' study was to identify clinical and histologic findings associated with the development of acellular dermal matrix-associated contracture.
The authors performed a retrospective cohort study of all patients undergoing bilateral implant-based breast reconstruction performed by the senior author (M.S.A.). Patients were excluded if they had radiation therapy to the breast. Patients with suspected acellular dermal matrix-associated contracture were identified by clinical photographs and review of operative notes. Histologic analysis was performed on specimens taken from two patients with acellular dermal matrix contracture.
The authors included a total of 46 patients (92 breasts), of which 19 breasts had suspected acellular dermal matrix-associated contracture. Acellular dermal matrix contracture was less common in direct-to-implant reconstruction (4.2 percent versus 26.5 percent; p = 0.020) and more common in breasts that had seromas (0 percent versus 15.8 percent; p = 0.001) or complications requiring early expander replacement. Contracted acellular dermal matrix had less vascularity and a lower collagen I-to-collagen III ratio, and was twice as thick as noncontracted acellular dermal matrix.
The authors have described a distinct phenomenon of acellular dermal matrix-associated contracture that occurs in a small subset of breasts where acellular dermal matrix is used. This merits further investigation. Future work will be required to better characterize the clinical factors that make acellular dermal matrix-associated contracture more likely to occur.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
包膜挛缩是假体乳房重建术后一种公认的并发症。作者观察到，一些接受乳房重建的患者在接受组织扩张器插入时，特定的去细胞真皮基质会发生挛缩。作者研究的目的是确定与去细胞真皮基质相关挛缩发展相关的临床和组织学发现。
作者对由资深作者（M.S.A.）进行的双侧植入物乳房重建的所有患者进行了回顾性队列研究。如果患者接受过乳房放疗，则将其排除在外。通过临床照片和手术记录的回顾，确定疑似去细胞真皮基质相关挛缩的患者。对两名患有去细胞真皮基质挛缩的患者的标本进行了组织学分析。
作者共纳入 46 名患者（92 只乳房），其中 19 只乳房疑似与去细胞真皮基质相关挛缩。直接植入重建的去细胞真皮基质挛缩较少见（4.2%对 26.5%；p = 0.020），而有血清肿（0%对 15.8%；p = 0.001）或需要早期扩张器更换的并发症的乳房更常见。挛缩的去细胞真皮基质血管较少，I 型胶原与 III 型胶原的比例较低，厚度是未挛缩的去细胞真皮基质的两倍。
作者描述了一种独特的去细胞真皮基质相关挛缩现象，这种现象发生在一小部分使用去细胞真皮基质的乳房中。这值得进一步研究。未来需要进行更多的工作来更好地描述使去细胞真皮基质相关挛缩更有可能发生的临床因素。
临床问题/证据水平：风险，III。
