Experimental and Clinical Investigation of the Implant Surface Roughness Reduction Effect on Early-stage Fibrosis

NCT ID: NCT05648929

Last Updated: 2024-03-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

14 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-01-20

Study Completion Date

2024-02-13

Brief Summary

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The goal of this single-center, randomised double-blinded trial is to compare the early stage fibrosis progression around conventional textured expander and the SmoothSilk® expander with reduced surface roughness in women undergoing bilateral nipple or skin sparing mastectomy in a prophylactic setting followed by tissue-expander based breast reconstruction. Researchers will compare intra-individually, the conventional textured expander CPX®(Mentor) and the SmoothSilk® (Motiva) expander (i) to gain a comprehensive insight into immunological mechanisms occurring at the timepoint of expander insertion (within the first days after implantation) based on WBF analysis in vitro, (ii)to determine the role and function of immune cells in a rather early stage of capsule formation (6-8 months after implantation) and under well-defined conditions in humans as well as (iii)to analyze the aesthetic outcome and clinical parameters after bilateral implant-based reconstruction using two expanders with varying surface topography within the individual patient (intra-individually).

Detailed Description

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Expander Immunology trial is a single-center, randomized double-blinded trial. A total of 14 patients, undergoing prophylactic bilateral simultaneous NSME (nipple sparing mastectomy) and implant based breast reconstruction, will receive either SmoothSilk® (Motiva Flora) or other routinely used expander (Mentor CPX™4), randomised to left or right breast after mastectomy. Patient and laboratory expert will be double-blinded. Clinical follow-up visits will be scheduled at 2, 4, 5, 6, 7, 8 and 16 weeks post procedure. Biological sample collection of wound bed fluid will take place daily from day 1 to 5 after expander implantation. Ultrasound will be performed -28 to-1 day before re-operation. Capsule tissue will be harvested and blood draw will be performed during re-operation between 24 to 28 weeks after initial expander implantation.

Directly postoperatively at day 1-5 after expander implantation, wound bed fluid will be collected and proteinaceous and cellular components will be analyzed via FACS (flow cytometry), molecular (RNA, protein) assays and microbiome testing platform.

Phenotypical and functional analyses will be performed for capsular tissue and blood as well as PCR (polymerase chain reaction) assays for bacterial antigens when expanders are changed to definite implants. Expanders will also undergo sonication to check for bacterial contamination. Peri-capsular tissue samples will be evaluated using scanning electron microscopy-energy dispersive x-ray spectroscopy (SEM-EDS) to identify sites with/without titanium particles (Titan-Bra debris). And breast ultrasound will be performed to detect capsular thickness before the reoperation.

During regular clinical examinations patients will go through a short questionnaire at week 4 and 16 to check patient satisfaction with expanders and adverse events will be monitored. (S)AE evaluation will be performed from Visit 1 (Day 0 = Expander implantation) to Visit 15 (Day 168-196 = Reoperation) according to visit plan.

The main question\[s\] it aims to answer are:

1. Does the immune cell profile differ within the wound-bed fluid (WBF) directly after implantation? Do the investigators see different activation patterns or distribution patterns of immune cells within the WBF on the conventional expander reconstructed side versus the SmoothSilk® (Motiva) reconstructed side?
2. Does the immune cell profile differ within the capsular tissue formed around conventional expanders versus SmoothSilk® (Motiva) expanders?
3. Which cytokines are mainly expressed in the early capsular tissue (conventional expander versus SmoothSilk® (Motiva) and do the investigators see differences in comparison with those of peripheral blood?
4. Does the cellular composition (histology) show different distribution patterns of immune cells and ECM proteins in these capsules?
5. Do the investigators see differences concerning bacterial \& fungi contamination in WBF and on expander shells at the time point of explantation (sonication and PCR as well as next-generation DNA sequencing for bacteria and fungi)
6. Do the investigators see titanium wear particle incorporation into peri-capsular tissue? Is there a difference between the conventional expanders versus SmoothSilk® (Motiva) expanders after 6-8 months?
7. Do the investigators see any differences in outcome analysis between the conventional expanders versus Motiva nano-textured expanders after 6-8 months (Seroma formation, Implant dislocation, thickness of capsule)?

Conditions

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Capsular Contracture Associated With Implant Foreign-Body Reaction Wounds and Injuries Tissue Expander Disorder

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

intraindividual comparative analysis of two different devices implanted within one individual patient.
Primary Study Purpose

OTHER

Blinding Strategy

TRIPLE

Participants Caregivers Outcome Assessors
randomised double-blinded trial: A total of 14 patients will receive either Motiva SmoothSilk® or other routinely used expander (Mentor CPX™4) randomized to left or right breast after mastectomy. Patient and laboratory expert will be double-blinded.

Study Groups

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the conventional expander Mentor CPX4 (MENTOR)

intraindividual comparison of two differentially rough tissue expanders

Arm description: women undergoing prophylactic bilateral NSME and simultaneous tissue-expander based reconstruction with conventionally textured expander with surface roughness 60µM Ra

Group Type ACTIVE_COMPARATOR

Patient Satisfaction Questionnaire

Intervention Type OTHER

During regular clinical examinations patient will go through a short questionnaire at week 4, 16 and 24 to check patient satisfaction with expanders

Pregnancy test

Intervention Type DIAGNOSTIC_TEST

Pre-op; to sufficiently check pregnancy as exclusion criteria

Blood draw

Intervention Type PROCEDURE

pre- expander implantation, alongside anaesthesia pre- expander explantation and exchange with definite implant alongside anaesthesia - no additional vein irritation needed

Expander based breast reconstruction

Intervention Type PROCEDURE

implantation of 2 different expanders intraindividually

Ultrasound of breast

Intervention Type PROCEDURE

Measurement of capsular thickness pre- expander removal

S(AE )monitoring

Intervention Type OTHER

(S)AE evaluation will be performed from Visit 1 (Day 0 = Expander implantation) to Visit 15 (Day 168-196 = Reoperation) according to visit plan.

the expander SmoothSilk(Motiva) with reduced surface roughness

intraindividual comparison of two differentially rough tissue expanders

Arm description: women undergoing prophylactic bilateral NSME and simultaneous tissue-expander based reconstruction with reduced textured expander with surface roughness 4µM Ra

Group Type ACTIVE_COMPARATOR

Patient Satisfaction Questionnaire

Intervention Type OTHER

During regular clinical examinations patient will go through a short questionnaire at week 4, 16 and 24 to check patient satisfaction with expanders

Pregnancy test

Intervention Type DIAGNOSTIC_TEST

Pre-op; to sufficiently check pregnancy as exclusion criteria

Blood draw

Intervention Type PROCEDURE

pre- expander implantation, alongside anaesthesia pre- expander explantation and exchange with definite implant alongside anaesthesia - no additional vein irritation needed

Expander based breast reconstruction

Intervention Type PROCEDURE

implantation of 2 different expanders intraindividually

Ultrasound of breast

Intervention Type PROCEDURE

Measurement of capsular thickness pre- expander removal

S(AE )monitoring

Intervention Type OTHER

(S)AE evaluation will be performed from Visit 1 (Day 0 = Expander implantation) to Visit 15 (Day 168-196 = Reoperation) according to visit plan.

Interventions

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Patient Satisfaction Questionnaire

During regular clinical examinations patient will go through a short questionnaire at week 4, 16 and 24 to check patient satisfaction with expanders

Intervention Type OTHER

Pregnancy test

Pre-op; to sufficiently check pregnancy as exclusion criteria

Intervention Type DIAGNOSTIC_TEST

Blood draw

pre- expander implantation, alongside anaesthesia pre- expander explantation and exchange with definite implant alongside anaesthesia - no additional vein irritation needed

Intervention Type PROCEDURE

Expander based breast reconstruction

implantation of 2 different expanders intraindividually

Intervention Type PROCEDURE

Ultrasound of breast

Measurement of capsular thickness pre- expander removal

Intervention Type PROCEDURE

S(AE )monitoring

(S)AE evaluation will be performed from Visit 1 (Day 0 = Expander implantation) to Visit 15 (Day 168-196 = Reoperation) according to visit plan.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Age \> 18 years
* Female sex
* High risk family history for mammary and/or ovarian cancer
* Planned prophylactic mastectomy with simultaneous breast reconstruction
* Signed informed consent form

Exclusion Criteria

* Confirmed sever Coagulation disorder, representing a potential contraindication for the elective surgery
* Confirmed Rheumatic disease accompanied by obligatory intake of immunomodulating therapeutic agents
* Confirmed severe renal functional disorder: Renal insufficiency status IV or V
* Active hematological or oncological disease
* HIV-Infection
* Hepatitis-Infection
* Pregnancy or breast feeding
* Intake of anti-inflammatory drugs
* Carrier of silicone implants (e.g. gastric banding, mammary implants)
* Subject is currently participating or intends to participate in another clinical trial that may interfere with the protocol of this study
* Patients who have implanted devices that could be affected by a magnetic field (e.g., pacemakers, drug infusion devices, artificial sensing devices) \* patients with removable devices such as removable diabetes pumps, sensors and transmitter might still part take,
* Patients with alteration in hematologic and serum protein reference values post-chemotherapy.
* When there is a residual malignancy in the intended expansion site.
* Existing tissue at the intended expansion site is not adequate according to the surgeon's criteria, because of previous radiation therapy, ulcerations, vascular compromise, history of compromised wound healing, or scar deformity.
* Radiation therapy before or after the expander placement can be associated with a higher rate of complications during the expansion and final implantation phases of the reconstructive process.
* Abscess or infection in the body in general.
* Participants with autoimmune diseases (e.g., lupus, scleroderma) or whose immune system is compromised (e.g., currently receiving immunosuppressive therapy such as steroids).
* Unsuitable tissue due to radiation damage on the chest wall, tight thoracic skin grafts or radical resection of the pectoralis major muscle.
Minimum Eligible Age

18 Years

Maximum Eligible Age

99 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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Medical University Innsbruck

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Dolores Wolfram-Raunicher, Dr.

Role: PRINCIPAL_INVESTIGATOR

Medical University of Innsbruck, Department for Plastic Surgery

Locations

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Medical University of Innsbruck, Department for Plastic, Aethetic and Reconstructive Surgery

Innsbruck, Tyrol, Austria

Site Status

Countries

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Austria

References

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Schoberleitner I, Augustin A, Egle D, Brunner C, Amort B, Zelger B, Brunner A, Wolfram D. Is It All about Surface Topography? An Intra-Individual Clinical Outcome Analysis of Two Different Implant Surfaces in Breast Reconstruction. J Clin Med. 2023 Feb 7;12(4):1315. doi: 10.3390/jcm12041315.

Reference Type RESULT
PMID: 36835850 (View on PubMed)

Schoberleitner I, Faserl K, Sarg B, Egle D, Brunner C, Wolfram D. Quantitative Proteomic Characterization of Foreign Body Response towards Silicone Breast Implants Identifies Chronological Disease-Relevant Biomarker Dynamics. Biomolecules. 2023 Feb 6;13(2):305. doi: 10.3390/biom13020305.

Reference Type RESULT
PMID: 36830674 (View on PubMed)

Related Links

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Other Identifiers

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EIT2020

Identifier Type: -

Identifier Source: org_study_id

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