Effect of hydration time on the microstructure of a porcine acellular dermal matrix for breast reconstruction: a pilot study.

Abstract

Acellular dermal matrices (ADMs) are integral to prepectoral direct-to-implant (P-DTI) breast reconstruction, enhancing structural support and mitigating complications such as capsular contracture, implant migration and soft tissue atrophy. Despite their widespread clinical use, hydration protocols remain empirical, lacking systematic validation. BRAXONFast, a porcine-derived one, is supplied in dehydrated form and requires rehydration for optimal handling and biointegration. The manufacturer recommends a minimum hydration time of 5 min in 0.9% sterile saline solution at 20 °C, but no evidence-based data confirm its impact on microstructure. This study evaluated the effects of hydration time on BRAXONFast architecture. 81 BRAXONFast samples were divided into 1 control group (dehydrated) and 8 experimental groups hydrated in sterile saline for 1, 3, 5, 7, 9, 15, 20, or 30 min. Hematoxylin-eosin staining and digital slide scanning were used for histological and morphometric analysis. White area percentage (%), indicating hydration-induced porosity, and collagen fiber diameter (μm), reflecting potential structural changes, were assessed. One-way ANOVA with Tukey's post-hoc test (α = 0.05) was applied. Complete decellularization was confirmed in all samples. White area percentage significantly increased after 5 min and plateaued by 30 min (p < 0.05). Collagen fiber diameters remained unchanged, suggesting hydration affected porosity without altering fiber morphology. This study provides the first systematic assessment of hydration-induced structural changes in BRAXONFast. Findings support the current 5-minute hydration recommendation, while suggesting potential benefits from extended hydration. Further studies are needed to optimize clinical protocols.