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Effects of Subcutaneous versus Submuscular Tissue Expander Placement on Breast Capsule Formation.

Tomita K, Yano K, Nishibayashi A, Hosokawa K - Plast Reconstr Surg Glob Open (2015)

Bottom Line: We speculate that capsule formation might be different in subcutaneous TE placement compared with submuscular TE placement.Our findings show that subcutaneous TE placement results in thinner capsule formation with low vascularity when compared with submuscular TE placement (354 ± 96 μm and 589 ± 92 μm, respectively; P < 0.001).Although further study is needed, differences in vascularity between subcutaneous tissue and muscle might affect the thickness of capsules.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.

ABSTRACT
In autologous breast reconstruction, skin envelope reconstruction is especially important given the flexibility of new breast parenchyma. Our experience suggests a better control of breast shape with subcutaneous tissue expander (TE) placement compared with submuscular TE placement. We speculate that capsule formation might be different in subcutaneous TE placement compared with submuscular TE placement. To elucidate this hypothesis, we collected capsules formed around the TE in two-stage breast reconstruction patients and evaluated differences in histology and capsule wall thickness between subcutaneous (n = 7) and submuscular (n = 8) TE placement. Our findings show that subcutaneous TE placement results in thinner capsule formation with low vascularity when compared with submuscular TE placement (354 ± 96 μm and 589 ± 92 μm, respectively; P < 0.001). Because thin connective tissue can reduce postoperative shrinkage of the skin envelope, it would be beneficial to predict and control the shape of reconstructed breast. Although further study is needed, differences in vascularity between subcutaneous tissue and muscle might affect the thickness of capsules.

No MeSH data available.


Capsule specimens were collected from the center of the dome and stained with Masson’s trichrome. Representative sections in subcutaneous group (A) and submuscular group (B) are shown.
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Figure 1: Capsule specimens were collected from the center of the dome and stained with Masson’s trichrome. Representative sections in subcutaneous group (A) and submuscular group (B) are shown.

Mentions: Most capsules consisted of 3 layers as previously reported,5 that is, the inner layer in contact with the TE, the middle layer with dense connective tissue, and the outer layer with loose connective tissue and high vascularity. In the submuscular group, connective tissue in the middle layer was relatively thick, and large-diameter blood vessels were found in the middle layer and in the outer layer (Fig. 1B). By contrast, in the subcutaneous group, the middle layer was composed of thin avascular connective tissue, and the vascularity of the outer layer was low with some small-diameter vessels (Fig. 1A). The capsule wall was significantly thinner in the subcutaneous group (354 ± 96 μm) than in the submuscular group (589 ± 92 μm; P < 0.001).


Effects of Subcutaneous versus Submuscular Tissue Expander Placement on Breast Capsule Formation.

Tomita K, Yano K, Nishibayashi A, Hosokawa K - Plast Reconstr Surg Glob Open (2015)

Capsule specimens were collected from the center of the dome and stained with Masson’s trichrome. Representative sections in subcutaneous group (A) and submuscular group (B) are shown.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4494502&req=5

Figure 1: Capsule specimens were collected from the center of the dome and stained with Masson’s trichrome. Representative sections in subcutaneous group (A) and submuscular group (B) are shown.
Mentions: Most capsules consisted of 3 layers as previously reported,5 that is, the inner layer in contact with the TE, the middle layer with dense connective tissue, and the outer layer with loose connective tissue and high vascularity. In the submuscular group, connective tissue in the middle layer was relatively thick, and large-diameter blood vessels were found in the middle layer and in the outer layer (Fig. 1B). By contrast, in the subcutaneous group, the middle layer was composed of thin avascular connective tissue, and the vascularity of the outer layer was low with some small-diameter vessels (Fig. 1A). The capsule wall was significantly thinner in the subcutaneous group (354 ± 96 μm) than in the submuscular group (589 ± 92 μm; P < 0.001).

Bottom Line: We speculate that capsule formation might be different in subcutaneous TE placement compared with submuscular TE placement.Our findings show that subcutaneous TE placement results in thinner capsule formation with low vascularity when compared with submuscular TE placement (354 ± 96 μm and 589 ± 92 μm, respectively; P < 0.001).Although further study is needed, differences in vascularity between subcutaneous tissue and muscle might affect the thickness of capsules.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.

ABSTRACT
In autologous breast reconstruction, skin envelope reconstruction is especially important given the flexibility of new breast parenchyma. Our experience suggests a better control of breast shape with subcutaneous tissue expander (TE) placement compared with submuscular TE placement. We speculate that capsule formation might be different in subcutaneous TE placement compared with submuscular TE placement. To elucidate this hypothesis, we collected capsules formed around the TE in two-stage breast reconstruction patients and evaluated differences in histology and capsule wall thickness between subcutaneous (n = 7) and submuscular (n = 8) TE placement. Our findings show that subcutaneous TE placement results in thinner capsule formation with low vascularity when compared with submuscular TE placement (354 ± 96 μm and 589 ± 92 μm, respectively; P < 0.001). Because thin connective tissue can reduce postoperative shrinkage of the skin envelope, it would be beneficial to predict and control the shape of reconstructed breast. Although further study is needed, differences in vascularity between subcutaneous tissue and muscle might affect the thickness of capsules.

No MeSH data available.