Safety and histologic characteristics of aseptic and sterile acellular dermal matrices in irradiated implant-based breast reconstruction.

Abstract

Acellular dermal matrices (ADMs) are widely used in implant-based breast reconstruction to enhance esthetic outcomes and reduce capsular contracture. However, concerns persist regarding their performance in patients undergoing postmastectomy radiation therapy (PMRT). The impact of ADM processing method-aseptic versus sterile-on clinical outcomes and postirradiation tissue characteristics remains incompletely defined. To compare clinical outcomes, patient-reported satisfaction, and histologic characteristics of aseptic and sterile ADMs in implant-based breast reconstruction followed by PMRT. This study included 157 patients (100 aseptic and 57 sterile) who underwent two-stage implant-based reconstruction with PMRT between 2018 and 2022. Postoperative complications and patient-reported outcomes (BREAST-Q) were analyzed. Postirradiation biopsy specimens from 66 patients were evaluated for tissue thickness and fibrosis-related markers (α-smooth muscle actin [α-SMA] and vimentin). Scanning electron microscopy was performed to qualitatively evaluate collagen ultrastructure following irradiation. During a mean follow-up of 39.8 months, no significant differences were observed between the groups in postoperative infection, capsular contracture, or overall complication rates. BREAST-Q scores for satisfaction, psychosocial well-being, sexual well-being, and physical well-being were comparable. Histologic analysis demonstrated no significant differences in ADM thickness. Expression of α-SMA and vimentin did not differ between the groups, indicating similar myofibroblast and fibroblast activity. Qualitative SEM assessment demonstrated preservation of collagen architecture in sterile ADM after irradiation. Aseptic and sterile ADMs demonstrated comparable safety profiles, patient-reported outcomes, and histologic characteristics in implant-based breast reconstruction with PMRT. Both ADM processing methods appear to be safe and effective options in the setting of PMRT.