Safety and histologic characteristics of aseptic and sterile acellular dermal matrices in irradiated implant-based breast reconstruction

BACKGROUND: Acellular dermal matrices (ADMs) are widely used in implant-based breast reconstruction to enhance esthetic outcomes and reduce capsular contracture. However, concerns persist regarding their performance in patients undergoing postmastectomy radiation therapy (PMRT). The impact of ADM processing method-aseptic versus sterile-on clinical outcomes and postirradiation tissue characteristics remains incompletely defined. OBJECTIVES: To compare clinical outcomes, patient-reported satisfaction, and histologic characteristics of aseptic and sterile ADMs in implant-based breast reconstruction followed by PMRT. METHODS: This study included 157 patients (100 aseptic and 57 sterile) who underwent two-stage implant-based reconstruction with PMRT between 2018 and 2022. Postoperative complications and patient-reported outcomes (BREAST-Q) were analyzed. Postirradiation biopsy specimens from 66 patients were evaluated for tissue thickness and fibrosis-related markers (α-smooth muscle actin [α-SMA] and vimentin). Scanning electron microscopy was performed to qualitatively evaluate collagen ultrastructure following irradiation. RESULTS: During a mean follow-up of 39.8 months, no significant differences were observed between the groups in postoperative infection, capsular contracture, or overall complication rates. BREAST-Q scores for satisfaction, psychosocial well-being, sexual well-being, and physical well-being were comparable. Histologic analysis demonstrated no significant differences in ADM thickness. Expression of α-SMA and vimentin did not differ between the groups, indicating similar myofibroblast and fibroblast activity. Qualitative SEM assessment demonstrated preservation of collagen architecture in sterile ADM after irradiation. CONCLUSION: Aseptic and sterile ADMs demonstrated comparable safety profiles, patient-reported outcomes, and histologic characteristics in implant-based breast reconstruction with PMRT. Both ADM processing methods appear to be safe and effective options in the setting of PMRT.