The effect of acellular matrix, nanofiber polylactic acid and nanofiber polylactic acid containing acellular matrix on capsule contracture in silicones and comparison of these effects

BACKGROUND: The increasing prevalence of aesthetic breast augmentation and implant-based breast reconstruction has brought with it the necessity to manage the complications brought by these operations. Pathological contraction of the capsule structure around the implant may present with pain, deformity, and re-operation indication. Biological meshes are widely used to reduce capsule contracture. PURPOSE: Acellular matrices that are not produced from dermal components are used cost-effectively because the cost of acellular matrix with dermal components is high in the increasingly widespread use of biological mesh. In our study, we aimed to study the efficacy of Endoform, an acellular dermal matrix produced from sheep gastric submucosa, and compare this efficacy with polylactic acid (PLA), a synthetic mesh. MATERIAL AND METHODS: The study was conducted on 4 groups of 28 rats, with 7 rats in each group. Submuscular silicones were placed in the dorsal regions of the rats. In the 1st group, only silicone was used, in the 2nd group silicone wrapped with PLA, in the 3rd group silicone wrapped with acellular matrix, and in the 4th group, acellular matrix loaded PLA-wrapped silicone was used. After the operation, the rats were followed up for 8 weeks under equal and optimal conditions, then they were re-operated and the skin, capsule and silicone were excised in an en-block manner and sent for histopathological examination. RESULTS: It was determined that there was a statistically higher rate of moderate to significant fibrosis in Group 2 compared to Group 1 (p=0.015). There was no statistically significant difference between Group 1 and Group 3 in the distribution of inflammation, granulation tissue, angiogenesis, fibrosis and foreign body reaction results (p>0.05). Granulation tissue was detected at a higher rate in Group 2 compared to Group 3 (p=0.029). It was determined that there was a statistically significantly higher rate of moderate-significant grade fibrosis and moderate-significant foreign body reaction in Group 2 compared to Group III (p=0.005). It was determined that the capsule thickness in Group 1 rats was statistically significantly lower than the results in Group 3 and Group 4 rats (p=0.006). It was determined that the capsule thickness in Group 3 rats was statistically significantly lower than the results in Group 4 rats (p=0.042). CONCLUSION: We found that PLA increased fibrosis, acellular matrix increased capsule thickness, and PLA increased fibrosis, granulation tissue and foreign body reaction compared to acellular matrix. We believe that the acellular matrix may be effective in terms of wound healing by increasing angiogenesis, reducing the rate of inflammation and granulation tissue, but it does not have an effect on the capsule since it does not reduce foreign body reaction and fibrosis.