The Biology of Bio-Replacement

The Clinical Objective

Most medical implants remain “foreign bodies.” Acellular Bovine Pericardium Matrices (ABPM) represent a shift: under the right conditions, they do not just integrate: the scaffold is progressively replaced by the host’s endogenous tissue.


What is an ECM?

An Extracellular Matrix (ECM) is a non-crosslinked 3D collagen scaffold. Through specialized decellularization, cellular components are removed to minimize immunogenic response, preserving the natural architecture to support host tissue ingrowth.

Article content

The Source Matters

Not all biological matrices are the same. Whether derived from Human, Equine, Bovine, Porcine, or Ovine tissue, the specific origin dictates the inflammatory profile, integration rate, and remodeling quality.

Article content

The Distinction: ADM vs. ABPM

While many matrices are skin-derived (Acellular Dermal Matrix – ADM), ExaShape is derived from bovine pericardium (ABPM). Unlike dense dermal tissue, pericardium is naturally thin (0.5 mm), bilayer, and highly permeable, allowing for superior fluid exchange and faster revascularization.


Stage 1: Early Inflammation

Upon implantation, the early host response is dominated by M2 macrophages, triggering a pro-remodeling pathway rather than rejection. Multicentric data (n=65) demonstrates a high safety profile with zero significant capsular contracture (De Vita et al., 2024).

Article content

Stage 2: Active Neovascularization

The microporous structure of bovine pericardium facilitates rapid blood vessel formation within the matrix itself. In vivo ultrasound monitoring confirms progressive neovascularization over a 12-month period (Varvaras et al., 2023).

Article content

Stage 3: Cellular Colonization

The matrix acts as a functional bio-platform. Host fibroblasts migrate into the 3D network, initiating the synthesis of endogenous, native collagen.

Article content

Stage 4: Functional Remodeling

As a non-crosslinked material, the scaffold undergoes controlled enzymatic degradation. It is gradually replaced by vascularized, elastic host tissue, maintaining structural pocket stability throughout the transition.

Article content

The ExaShape Advantage

By utilizing a naturally thin, gamma-sterilized bovine pericardium, ExaShape balances viscoelastic properties with superficial host tissues. It provides high suture retention while facilitating predictable, synchronized biological integration.

Article content

Data from the largest multicentric study to date evaluating ABPM in prepectoral reconstruction demonstrates a favorable safety profile, supporting its use as a reliable and suitable biological option for selected patients.


Ready to evaluate the biological approach to prepectoral reconstruction? From M2 macrophage polarization to ultrasound-confirmed neovascularization, ExaShape ABPM is engineered for surgeons prioritizing predictable remodeling and long-term pocket stability.

Find out more here


Regulatory Disclaimer ExaShape is a CE-marked medical device (Acellular Bovine Pericardium Matrix) intended strictly for use by qualified healthcare professionals. The clinical observations referenced are based on specific peer-reviewed literature (De Vita et al., 2024; Varvaras et al., 2023). Individual patient outcomes may vary depending on patient anatomy, biological risk factors, comorbidities, and surgical technique. Prior to application, always refer to the official Instructions for Use (IFU) for complete indications, contraindications, warnings, and potential adverse events.