Acellular Dermal Matrix (Permacol®) for Heterologous Immediate Breast Reconstruction after Skin-Sparing Mastectomy in Patients with Breast Cancer: A Single-Institution Experience and a Review of the Literature

Abstract

ObjectiveSkin-sparing mastectomy (SSM) with immediate heterologous reconstruction is a safe oncological option in surgical therapy of early breast cancer. Permacol® is an acellular dermal matrix (ADM) placed between the implant and the skin to improve lower pole projection and implant coverage. The aim of our study was to evaluate the outcome with a focus on patient satisfaction after 6 months and to analyze physical changes of ADM.Methods10 patients who underwent SSM with Permacol® were analyzed retrospectively. All patients were followed using a satisfaction questionnaire and an ultrasound evaluation of the tissue thickness of the pectoralis muscle and the Permacol®.ResultsNo intraoperative complications were observed. One patient required removal of the implant for necrosis after 3 months. Half of the patients underwent secondary corrective surgery. A statistically significant thinning of the pectoralis muscle was observed, compared to the thickening of the Permacol®. A majority of the patients were satisfied with the operation, and we found a correlation between lower body mass index and patient satisfaction.ConclusionIn our small case series Permacol®-assisted immediate reconstruction is shown to be an option for selected cases. Physical changes of Permacol® result in a symmetrical coverage of the implant, which may improve cosmetic outcome.

Clinical applications of acellular dermal matrices: A review

“… 54 By facilitating an optimal breast pocket, ADMs help to obtain symmetrical coverage, enhance the aesthetic outcome, decrease pain from pectoralis muscle mobilisation and reduce scarring. 57 , 62 Limited capsule contracture and scarring may also be attributed to the decreased inflammatory response associated with ADMs. 63 , 64 Additionally, it is more difficult for scar tissue or capsules to develop on the ADM surface.…”

“…2,50,51 While individual reports vary, aggregate data indicate that complications are rare. [52][53][54][55][56][57] A systematic review of 1039 breast reconstructions with either PADM or HADM showed low overall rates of skin and nipple necrosis (11% and 5%, respectively), infection (12%), hematoma (1%) and seroma (5%), with only 9% of patients requiring reoperation. 52 This success may be attributed to ADMs' ability to fully integrate into host tissue with neovascularisation, cell repopulation and lack of inflammatory cells observed at both short-and long-term follow-up.…”

Breast Reconstruction after Mastectomy with the Use of an Implant and Serratus Anterior Fascia Flap—Initial Clinical Evaluation

“…Moreover, combining ADM with expander two-stage reconstruction is considered to be significantly more expensive than using autologous/tissue expander combinations [39]. Tissue integration of an ADM is related to vascular ingrowth of the matrix, and the CEUS in vivo evaluation by Parvizi et al reported enhancement in the ADM after a month [40]. Ballesio et al attested with a US examination partial integration of ADM at six months of follow-up and complete integration at 12 months.…”

Eficácia Da Cirurgia Endoscópica No Tratamento Da Rinossinusite Crônica: Revisão De Literatura

“…A matriz é colocada entre o implante e a pele para melhorar a projeção do polo inferior mamário e a cobertura do implante com o intuito de evitar o uso de retalhos miocutâneos, bem como prevenir deformações mamárias, contraturas e exposição do implante. Outra vantagem dessa matriz é seu baixo custo em relação a outras MDAs (KNABBEN et al, 2017).…”