Abstract: Is There a Preferable Acellular Dermal Matrix - Breast Implants Match: A Comparative Electron Microscopy Scanning of Two Different Implant-Matrix Interfaces

Abstract

INTRODUCTION: Our goal is to characterize the ultrastructure at the interface of two textured expanders (Allergan BIOCELL® and Mentor SILTEX®) and an Acellular Dermal Matrix Alloderm®, through a prospective randomized study, using scanning electron microscopy. METHODS: We prospectively included who had a two stages breast reconstruction with an acelullar dermal matrix Alloderm®. Five patients had a Mentor Siltex® expander and 5 had an Allergan Biocell ® expander. Two cm2 periprosthetic capsule specimens were sampled en bloc with the implant during expander to permanent implant exchange. One at the junction between Alloderm® and the pectoralis major muscle and one at the site of Alloderm ® All samples were analyzed under SEM using High Vacuum (HiVac) modes and Energy dispersive X-ray (EDX) studies. Observations were charted in order to tally and objectivise three parameters: texture/cellularity /presence of biofilm and bacteria These measurements were performed using Adobe Photoshop software (Adobe® Photoshop® CS6 Extended). This software allows for measurements of distance between two points on an image with a 2% margin of error. RESULTS: In Group 1: Biocell®/Alloderm ®, We found no macro texture ingrowth of the capsule on the pores of the textured implants (Velcro-effect) at the implant-matrix interface. And a strong bacterial colonization of the implant porous surface, with presence of biofilm in 3 cases. In group 2 Siltex® / Alloderm ®, we found a smooth capsule surface but significantly less bacterial and no biofilm development. CONCLUSION: The lack of Velcro effect on the Biocell® implant in front of Alloderm ®, facilitate bacterial seeding, propagation and the formation of a biofilm in 3 of the specimens. The findings can help guide clinical decision making with regards to selecting the most optimal implant surface when employing an acelullar dermal matrix, in order to minimize long-term complications. DISCLOSURE/FINANCIAL SUPPORT:M Alain Danino is a consultant for Allergan and Johnson and Johnson None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.