Biologic Response With and Without Acellular Dermal Matrix in Breast Reconstruction

Acellular dermal matrices (ADMs) are biologic meshes commonly used in implant-based breast reconstruction (IBBR) procedures to provide implant support and coverage. Although the etiology is not well understood, increasing preclinical and clinical evidence suggest that ADMs may help prevent capsular contracture, a frequent complication of IBBR, by modulating the inflammatory response in the tissue surrounding breast implants. The objective of this narrative review is to discuss the evidence supporting the role of inflammation in capsular contracture following IBBR without ADM, and to characterize the potential mechanism(s) by which ADMs may reduce the incidence of capsular contracture in IBBR.

Relevant studies in English published up to December 31, 2023, were identified from 4 databases (BIOSIS Previews, Embase, MEDLINE, and Northern Light Life Sciences Conference Abstracts) using search terms such as "breast" and "capsular contracture."

This review discusses the potential factors (eg, expander-to-implant reconstruction, diminished collagen integrity, postmastectomy radiation therapy, surface of implant, plane of placement, incision type, hematoma, seroma, postoperative infection, and biofilm) and emerging biomarkers (eg, NRG1, IL-8, TIMP-1, TIMP-2, TIMP-4, MMP2, MMP12, ACAN, SAA1, TNFSF11, and hyaluronan) that may be able to predict capsular contracture. The available evidence that tissue integration of ADMs modulates the wound healing process and inflammation, and the available clinical evidence, which indicates that ADMs may decrease rates of capsular contracture following postmastectomy radiation therapy, are summarized.

The studies summarized in this review suggest that ADMs may reduce the likelihood of capsular contracture in IBRR compared with no ADM use.