Emma Hanssona,b,c, Pawel Buriandand Håkan Hallberga,ba

The Sahlgrenska Academy, Department of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden; bDepartment of Plastic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; cFaculty of Medicine, Lund University, Lund, Sweden; dDepartment of Pathology, Unilabs, Skövde, Sweden

ABSTRACT

The aim of this study was to compare inflammatory response and synovial metaplasia in implant-basedimmediate breast reconstruction with a biological mesh (VeritasVR) with that of a synthetic mesh (TIGRVRMatrix Surgical Mesh). We hypothesize that the inflammatory response and formation of synovial meta-plasia might be different and the rate of capsular contracture therefore different. The patients wererecruited from the Gothenburg TIGRVR/VeritasVRStudy (ClinicalTrials.Gov identifier NCT02985073). All refer-rals for bilateral immediate breast reconstruction were assessed for inclusions. During the operation, thepatients were randomized to which sides the biological and the synthetic mesh were going to beapplied. During the implant exchange biopsies were taken. Biopsies were taken from 30 breasts in 15patients. There seem to be more myofibroblast and neovascularization in the biological meshes than inthe synthetic and the collagen fibers seem to be aligned in an irregular pattern with both parallel andvertical fibers. In the synthetic meshes, there were more giant cells and foreign body reaction and thecollagen fibers were loosely and well aligned, oriented parallel to the surface of the implant. Synovialmetaplasia was seen in the majority of both the biological and the synthetic meshes. The histological pat-terns in early capsules from biological and synthetic meshes vary considerably. Nonetheless, it is unknownwhat role different cell types have in capsular formation in the long run and there was no difference inclinical capsular contracture at the clinical follow-up in this study.