[Is scanning electron microscopy a pertinent tool for the analysis of periprostethic breast capsules?]

Scanning electron microscopy (SEM) is a powerful analytical tool that allows the study of interactions between commonly used biomaterials and the human body. In conventional SEM (HiVac), hydrated biological samples cannot be analyzed in their natural state and must be dried and metallized. The primary goal of this study is to present recent developments in SEM, notably Environmental SEM (ESEM). The secondary objective is to define the potential utility of these new technologies in the study of periprosthetic breast capsules.

Our pilot study group prospectively included 10 patients with breast cancer undergoing 2-stage expander to implant reconstruction. Periprosthetic breast capsule specimens were sampled during expander removal. Each sample was analyzed using both HiVac and ESEM modalities. Energy dispersive X-ray (EDX) studies were also conducted in order to assess the chemical composition of the capsular tissue samples. Under each observation mode, comparisons of samples' three-dimensional surface relief, cellular composition and biofilm presence were made. For each image, a score from 1-3 on a Likert scale was attributed by three independent experts in electron microscopy.

HiVac mode was found to be superior to ESEM for the assessment of the three main study parameters (surface relief, cellularity, biofilm). The quality of the EDX analysis was equivalent under both SEM modalities.

HiVac mode was shown to be more appropriate than ESEM for the global analysis of periprosthetic breast capsules. EDX analysis permits the identification of atypical chemical elements in tissue samples.