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Marques-Piubelli ML, Lyapichev KA, Fnu A, Adrada B, Stewart J, Hunt KK, Clemens MW, Iyer S, Wu Y, El Hussein S, Xu J, Ok CY, Li S, Pierson DM, Ferrufino-Schmidt MC, Nahmod KA, Yoga A, Hunsicker L, Evans MG, Resetkova E, Qiu L, Khanlari M, Garces SA, Bueso-Ramos CE, Medeiros LJ, Miranda RN. The Spectrum of Non-neoplastic Changes Associated With Breast Implants: Histopathology, Imaging, and Clinical Significance. Am J Surg Pathol 2024; 48:e43-e64. [PMID: 38451836 DOI: 10.1097/pas.0000000000002198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Breast implant-associated anaplastic large cell lymphoma has been recognized as a distinct entity in the World Health Organization classification of hematolymphoid neoplasms. These neoplasms are causally related to textured implants that were used worldwide until recently. Consequently, there is an increased demand for processing periprosthetic capsules, adding new challenges for surgeons, clinicians, and pathologists. In the literature, the focus has been on breast implant-associated anaplastic large cell lymphoma; however, benign complications related to the placement of breast implants occur in up to 20% to 30% of patients. Imaging studies are helpful in assessing patients with breast implants for evidence of implant rupture, changes in tissues surrounding the implants, or regional lymphadenopathy related to breast implants, but pathologic examination is often required. In this review, we couple our experience with a review of the literature to describe a range of benign lesions associated with breast implants that can be associated with different clinical presentations or pathogenesis and that may require different diagnostic approaches. We illustrate the spectrum of the most common of these benign disorders, highlighting their clinical, imaging, gross, and microscopic features. Finally, we propose a systematic approach for the diagnosis and handling of breast implant specimens in general.
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Affiliation(s)
| | - Kirill A Lyapichev
- Department of Pathology, University of Texas Medical Branch, Galveston, TX
| | | | | | | | | | | | - Swaminathan Iyer
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston
| | | | - Siba El Hussein
- Department of Pathology, The University of Vermont Larner College of Medicine, Burlington, VT
| | - Jie Xu
- Department of Hematopathology
| | | | | | - Diane M Pierson
- Department of Pathology, Kings Daughters Medical Center, Ashland, KY
| | | | | | - Arthy Yoga
- Houston Methodist, Breast Surgical Oncology, Houston, TX
| | - Lisa Hunsicker
- Revalla Plastic Surgery and Medical Esthetics, Denver, CO
| | | | | | - Lianqun Qiu
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - Mahsa Khanlari
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
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Durando M, Ferrando PM, Dianzani C, Galioto F, Mariscotti G, Regini E, Bartoli G, Malan F, Bogetti P, Fonio P. Acellular dermal matrix imaging features in breast reconstructive surgery: a pictorial review. Br J Radiol 2024; 97:505-512. [PMID: 38419148 DOI: 10.1093/bjr/tqad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 10/29/2023] [Accepted: 11/29/2023] [Indexed: 03/02/2024] Open
Abstract
Acellular dermal matrices (ADMs) are biological engineered tissues, which may provide an immunologically inert scaffold in breast reconstruction. Since the literature on imaging features of ADMs is limited, radiologists must be aware of the common imaging appearances of ADM, to differentiate normal conformation from residual or recurrent disease. Our purpose is to review the current role of ADMs in implant-based breast reconstruction, describing the normal imaging findings at ultrasound, mammography, and MRI also considering the possible changes over time. In this pictorial essay, we reviewed imaging features of ADMs described in the literature and we reported our experience in patients who underwent reconstructive surgery with human or animal ADM for newly diagnosed breast cancer.
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Affiliation(s)
- Manuela Durando
- Radiology - University of Turin; Department of Diagnostic Imaging and Interventional Radiology; Presidio Ospedaliero Molinette - A. O. U. Città della Salute e della Scienza di Torino; Via Genova 3, Torino, 10126, Italy
| | - Pietro Maria Ferrando
- Plastic Surgery Department; Presidio ospedaliero CTO - A. O. U. Città della Salute e della Scienza di Torino; Via Zuretti, 29, Torino, 10126, Italy
| | - Chiara Dianzani
- Radiology - University of Turin; Department of Diagnostic Imaging and Interventional Radiology; Presidio Ospedaliero Molinette - A. O. U. Città della Salute e della Scienza di Torino; Via Genova 3, Torino, 10126, Italy
| | - Francesca Galioto
- Radiology - University of Turin; Department of Diagnostic Imaging and Interventional Radiology; Presidio Ospedaliero Molinette - A. O. U. Città della Salute e della Scienza di Torino; Via Genova 3, Torino, 10126, Italy
| | - Giovanna Mariscotti
- Radiology - University of Turin; Department of Diagnostic Imaging and Interventional Radiology; Presidio Ospedaliero Molinette - A. O. U. Città della Salute e della Scienza di Torino; Via Genova 3, Torino, 10126, Italy
| | - Elisa Regini
- Radiology - University of Turin; Department of Diagnostic Imaging and Interventional Radiology; Presidio Ospedaliero Molinette - A. O. U. Città della Salute e della Scienza di Torino; Via Genova 3, Torino, 10126, Italy
| | - Germana Bartoli
- Radiology - University of Turin; Department of Diagnostic Imaging and Interventional Radiology; Presidio Ospedaliero Molinette - A. O. U. Città della Salute e della Scienza di Torino; Via Genova 3, Torino, 10126, Italy
| | - Fabrizio Malan
- Plastic Surgery Department; Presidio ospedaliero CTO - A. O. U. Città della Salute e della Scienza di Torino; Via Zuretti, 29, Torino, 10126, Italy
| | - Paolo Bogetti
- Structure of Reconstructive and Aesthetic Plastic Surgery - University of Turin; Department of Surgical Sciences; Presidio Ospedaliero Molinette - A.O.U. Città della Salute e della Scienza di Torino; Torino, 10126, Italy
| | - Paolo Fonio
- Radiology - University of Turin; Department of Diagnostic Imaging and Interventional Radiology; Presidio Ospedaliero Molinette - A. O. U. Città della Salute e della Scienza di Torino; Via Genova 3, Torino, 10126, Italy
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Lee JH, Choi BG, Lee WS, Seo MG, Park BY, Kim YS, Park DY, Kim IK. Long-Term Ultrasonographic and Histologic Changes in Acellular Dermal Matrix in Implant-Based Breast Reconstructions. Plast Reconstr Surg 2023; 152:514-522. [PMID: 36827483 DOI: 10.1097/prs.0000000000010321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND Acellular dermal matrix (ADM) is composed of extracellular matrix (ECM) and is widely used in implant-based breast reconstructions. However, long-term changes in the ADM around implants have not been established. This study aimed to investigate long-term changes in the ADM covering breast implants using serial ultrasound and histologic evaluations. METHODS The authors evaluated the ultrasound results of 145 patients who underwent implant-based breast reconstructions with ADM coverings. The ultrasound results obtained within 18 months of surgery and those obtained 5 years postoperatively were analyzed to determine the change in ADM thickness. For histologic analysis, the ADM was harvested from 30 patients who underwent secondary breast surgery. Histologic features of the ECM and cellular components within the ADM were compared at specific intervals from ADM implantation and the second operation (early ADM group, <18 months; late ADM group, >5 years postoperatively). RESULTS The ADM thickness on ultrasound examination was significantly decreased in the late ADM group compared with that in the early ADM group ( P < 0.001). Histologic analyses revealed that the late ADM group had less thickness with lower ECM levels versus the early ADM group. Increased infiltration of host cells, such as vascular endothelial cells, myofibroblasts, and immune cells, occurred in the late ADM group. CONCLUSIONS Implanted ADMs underwent gradual thinning over time, in addition to ECM reduction and infiltration of host cells. These findings are useful in understanding the natural course of ADMs currently used in implant-based breast reconstructions. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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Affiliation(s)
- Jun-Ho Lee
- From the Departments of Plastic and Reconstructive Surgery
| | - Bong Gyu Choi
- From the Departments of Plastic and Reconstructive Surgery
| | - Won Seob Lee
- From the Departments of Plastic and Reconstructive Surgery
| | - Min-Gi Seo
- From the Departments of Plastic and Reconstructive Surgery
| | - Bo-Yoon Park
- From the Departments of Plastic and Reconstructive Surgery
| | | | - Do Young Park
- Ophthalmology, Yeungnam University College of Medicine
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Il-Kug Kim
- From the Departments of Plastic and Reconstructive Surgery
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Application of Acellular Dermal Matrix in Gynaecology—A Current Review. J Clin Med 2022; 11:jcm11144030. [PMID: 35887793 PMCID: PMC9318528 DOI: 10.3390/jcm11144030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022] Open
Abstract
The aim of our study is to draw attention to the multitude of applications of acellular dermal matrix (ADM) in the surgical treatment of urogynaecological disorders, such as reduction in the reproductive organs, and in reconstructive gynaecology. Despite the existence of numerous operational methods and materials, the effectiveness of transvaginal operation is still insufficient. Native tissue operations are often not durable enough, while operations with synthetic materials have numerous side effects, such as infections, hematomas, vaginal erosion, or dyspareunia. Hence, the search continues for a different material with a better efficacy and safety profile than those previously mentioned. It seems that ADM can meet these requirements and be a useful material for urogynaecological surgery. Key words related to the usage of ADM in gynaecological reconstructive surgery were used to search relevant databases (NCBI MedLine, Clinical Key, Clinicaltrials.gov). This manuscript is based on 43 literature sources, 28 (65.11%) of which were released after 2016. Older sources are cited for the purpose of presenting basic science, or other important issues related to the manuscript. ADM seems to be an ideal material for urogynaecological and reconstructive surgery. It has high durability, and thus high effectiveness. Moreover, it does not have the side effects typical for synthetic materials. There are no reports of material rejection, erosion or dyspareunia directly related to the presence of the mesh. Due to the difficulties in obtaining ADM and the need to perform additional tests, this material is not common in routine clinical practice. Therefore, the number of cases and the size of the research groups are insufficient to clearly define the potential of mesh from biological tissue. However, the results are so promising that it is worth considering a wider introduction to the use of this material. Our hope is that increasing clinicians’ awareness of this topic will lead to more studies comparing methods using native tissues or synthetic materials and those using ADM.
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Lee WS, Park SO, Kim IK. Prevention of Abdominal Bulging Using Onlay Dermal Autografts from Discarded Zone IV TRAM Flap Tissue. J Clin Med 2022; 11:jcm11071929. [PMID: 35407538 PMCID: PMC8999363 DOI: 10.3390/jcm11071929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/26/2022] [Accepted: 03/29/2022] [Indexed: 02/04/2023] Open
Abstract
While the transverse rectus abdominis myocutaneous (TRAM) flap is a popular option for abdominal-based breast reconstruction, abdominal wall morbidities such as bulging or hernia remain a concern. Here, we introduced a surgical technique for reinforcing the abdominal wall using an onlay autograft obtained from discarded zone IV tissue following a primary closure. We compared abdominal wall morbidities between patients receiving an onlay graft and those receiving primary closure only. We retrospectively reviewed the medical charts of patients who underwent breast reconstruction using a TRAM flap between December 2018 and May 2021. Additionally, we assessed donor-site morbidities based on physical examination. Of the 79 patients included, 38 had received a dermal graft and 41 had not. Donor-site morbidities occurred in 10 (24.5%) and 1 (2.6%) patients, and bulging occurred in 8 (19.5%) and 1 (2.6%) patients in the primary closure and dermal autograft groups, respectively. A statistically significant difference in the incidence of bulging was observed between the groups (p = 0.030). In conclusion, the introduction of a dermal autograft after primary closure can successfully ameliorate morbidities at the TRAM flap site.
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Affiliation(s)
- Won Seob Lee
- Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, Daegu 42415, Korea;
| | - Seong Oh Park
- Department of Plastic and Reconstructive Surgery, Hanyang University College of Medicine, Seoul 04763, Korea
- Correspondence: (I.-K.K.); (S.O.P.); Tel.: +82-53-620-3480 (I.-K.K.); +82-2-2290-8564 (S.O.P.); Fax: +82-53-626-0705 (I.-K.K.); +82-2-2295-7671 (S.O.P.)
| | - Il-Kug Kim
- Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, Daegu 42415, Korea;
- Correspondence: (I.-K.K.); (S.O.P.); Tel.: +82-53-620-3480 (I.-K.K.); +82-2-2290-8564 (S.O.P.); Fax: +82-53-626-0705 (I.-K.K.); +82-2-2295-7671 (S.O.P.)
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