Oxidized regenerated cellulose in breast surgery: experimental model

Abstract

Background: Breast-conserving surgery (BCS) combined with postoperative radiotherapy has become the gold standard of locoregional treatment in patients with early-stage breast cancer. When large tumor resections are needed in small medium size breasts, oncoplastic procedures (OPP) have been introduced to improve the cosmetic result; but in several cases, OPP may be not sufficient to accomplish this purpose. Oxidized regenerated cellulose (ORC, Tabotamp fibrillar; Johnson & Johnson; Ethicon) has been reported to be useful in OPP to optimize the cosmetic results after OPP. However, no ultrastructural study is available on the use of ORC as a filler in BCS.

Materials and methods: A BCS cavity was simulated in both groin regions in 24 consecutive Wistar rats. The right groin underwent soft tissue displacement and ORC implantation, whereas the left groin was treated only by soft tissue displacement (control side). Rats were sacrificed at 10, 20, and 30 wk to evaluate volume retainment and microscopic features (vascularization, fibrosis, cell population, inflammation, liponecrosis, and capsule formation).

Results: The use of ORC was characterized by diffuse fibrosis and homogeneous neovascularization within the construct, with no capsule formation and no inflammation. Volume retainment was similar in the 20- and 30-wk specimens (mean 80.4%, standard deviation, 6.65 and mean 79.9%, standard deviation, 6.51).

Conclusions: Implanted ORC was well integrated within the soft tissue with diffuse fibrosis, angiogenesis, and absence of capsule formation. Preliminary results confirmed that this biomaterial could further contribute to optimize cosmetic results in the oncoplastic surgical spectrum of breast-conservation therapy.

Keywords: Breast cancer; Cosmetic results; Oncoplastic surgery; Oxidized regenerated cellulose; QUORC technique.