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Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
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Delaying implant-based mammary reconstruction after radiotherapy does not decrease capsular contracture: An in vitro
Mostafa El-Diwany1, Jean-Philippe Giot2, Marie-Josée Hébert3
1Department of Plastic Surgery, University of Montreal Health Centre, Montreal, QC, Canada; Montreal University Health Centre - Research Centre, Montreal, QC, Canada.
Summary
Radiotherapy causes permanent cellular changes leading to fibrosis and capsular contracture in breast reconstruction. Delaying reconstruction after radiation does not prevent these fibrotic complications.
Area of Science:
- Biomedical Engineering
- Oncology
- Plastic Surgery
Background:
- Fibrosis and capsular contracture are common complications of implant-based breast reconstruction post-radiotherapy.
- Adjuvant radiotherapy indications have expanded, increasing the number of patients requiring reconstruction after radiation.
- Current guidelines often recommend delaying reconstruction until after radiotherapy to mitigate fibrotic issues.
Purpose of the Study:
- To investigate whether radiotherapy permanently alters cellular properties affecting implant-based breast reconstruction.
- To determine if delaying reconstruction after radiotherapy offers benefits in preventing long-term fibrotic complications.
Main Methods:
- An in vitro model simulating irradiated and delayed implant-based mammary reconstruction was developed.
- Fibroblast and endothelial cell cultures were used to mimic surgical conditions.
- Cellular changes, including differentiation, cell cycle arrest, and growth factor secretion, were analyzed.
Main Results:
- Radiotherapy induced fibroblast differentiation into myofibroblasts, increasing alpha-smooth muscle actin, a marker for scar tissue contraction.
- Irradiated endothelial cells underwent senescence and secreted profibrotic connective tissue growth factor.
- Fibroblasts exposed to media from irradiated endothelial cells showed myofibroblast differentiation and fibrotic phenotypes.
Conclusions:
- Radiotherapy induces irreversible cellular alterations that permanently promote a fibrotic microenvironment.
- These permanent cellular changes suggest that delaying reconstruction does not prevent capsular contracture.
