Comparison of Different Acellular Dermal Matrices in Breast Reconstruction: The 50/50 Study

Pittman, Troy A.; Fan, Kenneth L.; Knapp, Andrew; Frantz, Shelby; Spear, Scott L.

doi:10.1097/prs.0000000000003048

Cited by 46 publications

(47 citation statements)

References 37 publications

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“…Previously, studies have suggested that AlloDerm has an increased rate of Red Breast Syndrome, however, only one case was identified in this study. 26 Capsular contracture (Grade III/IV) was seen in 3.0% of patients, which is similar to other reports in the literature, crediting ADM for being associated with low rates of capsular contracture when compared to implant-based reconstruction without ADM. 24,27 We need to outline, however, that the follow-up period, which has a wide range, precludes us from drawing definitive conclusions and possible underestimates the occurrence of capsular contracture in this patient population.…”

Section: Discussionsupporting

confidence: 86%

“…Reasons for this might include the number of drains and length of time that drains were left in place, which was somewhat longer than from reports of other groups. Previously, studies have suggested that AlloDerm has an increased rate of Red Breast Syndrome, however, only one case was identified in this study . Capsular contracture (Grade III/IV) was seen in 3.0% of patients, which is similar to other reports in the literature, crediting ADM for being associated with low rates of capsular contracture when compared to implant‐based reconstruction without ADM .…”

Section: Discussionsupporting

confidence: 82%

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Identifying risk factors for postoperative major complications in staged implant‐based breast reconstruction with AlloDerm

et al. 2019

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Acellular dermal matrices (ADM) have reportedly been associated with postoperative complications following breast reconstruction. The purpose of this study was to identify risk factors predictive of major postoperative complications after staged implant‐based breast reconstruction with ADM. A retrospective study of all patients who underwent implant‐based breast reconstruction with AlloDerm between 2013 and 2017 was conducted. Demographic information, procedural data, and postoperative complications were retrieved. The main objective was to analyze patient and procedural factors associated with the occurrence of major complications, including postoperative readmission and loss of reconstruction. A total of 166 patients (288 breasts) were included. Major complications were noted in 19.9%. The overall rate of infection and mastectomy skin necrosis was 16.9% and 6.6%, respectively. Readmission occurred in 16.3% and loss of reconstruction occurred in 8.4% of patients. Risk factors for major complications included body mass index (BMI) >27.0 kg/m2 (OR 2.46; p = 0.041), higher tissue expander volume (p = 0.049), history of chemotherapy (OR 2.20; p = 0.047) and radiotherapy (OR 2.22; p = 0.040). Loss of reconstruction was associated with a BMI >27.0 kg/m2 (OR 4.00; p = 0.012), tobacco use (OR 6.64, p = 0.006), and higher tissue expander volume (p = 0.035). Similarly, readmission was associated with higher tissue expander volume (p = 0.042). In conclusion, a variety of factors were identified to be associated with major complications, including higher BMI, increased tissue expander volume, as well as history of chemotherapy and radiation. This information is valuable for pre‐operative counseling and for future comparative studies between different ADM types.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 82%

Identifying risk factors for postoperative major complications in staged implant‐based breast reconstruction with AlloDerm

et al. 2019

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“…This allows for compliance during prosthetic breast reconstruction, maintaining lower pole coverage and support and allowing for more aesthetic contour. 8,11 Sbitany et al published a retrospective review comparing complete submuscular placement and partial subpectoral placement with an ADM inferior sling and reported that the use of ADM allowed for a greater initial fill volume of the tissue expander with 412 mL per expander in the ADM group versus 130 mL per expander in the total submuscular group (p ¼ 0.0001) as well as approximately three less fills for the ADM group versus the total submuscular group to complete the reconstruction. 4 The study concluded that using ADM may potentially improve cosmetic outcomes by capitalizing on preserved mastectomy skin as well offering the potential for more predictable revision surgeries.…”

Section: Pocket Creation and The Use Of Acellular Dermal Matrixmentioning

confidence: 99%

Latest Trends in Subpectoral Breast Reconstruction

Winocour

Lemaine³

2019

Seminars in Plastic Surgery

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There has been a shift in recent years toward a growing popularity of implant-based breast reconstruction, especially in the setting of increased frequency of concurrent contralateral prophylactic mastectomy. Advancements in implant safety and technology have also allowed for an expanding implant reconstruction practice across the country. The traditional approach is immediate two-stage implant reconstruction with placement of a tissue expander within a subpectoral pocket. The introduction of acellular dermal matrix has revolutionized implant-based breast reconstruction, allowing surgeons the opportunity to minimize morbidity while maximizing aesthetic outcomes. There have also been advances in the management of postoperative pain control as well as secondary revision surgery.

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“…Most importantly, initial transplantations of recellularized organs have demonstrated limited function leading to ultimate failure [ 89 – 91 ]. Nevertheless, it is promising to see that less complex decellularized human tissues such as skin, have been used for decades without any obvious immune rejection issues [ 92 , 93 ]. While whole organ engineering could lead to the ultimate cure for diseases such as heart and lung failure, the complex nature of tissue organization presents many challenges before this techniques is ready for therapeutic use.…”

Section: Part Ii: Microenvironmental Manipulation Of Cell Fates For Rmentioning

confidence: 99%

Tissue specific microenvironments: a key tool for tissue engineering and regenerative medicine

2017

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The accumulated evidence points to the microenvironment as the primary mediator of cellular fate determination. Comprised of parenchymal cells, stromal cells, structural extracellular matrix proteins, and signaling molecules, the microenvironment is a complex and synergistic edifice that varies tissue to tissue. Furthermore, it has become increasingly clear that the microenvironment plays crucial roles in the establishment and progression of diseases such as cardiovascular disease, neurodegeneration, cancer, and ageing. Here we review the historical perspectives on the microenvironment, and how it has directed current explorations in tissue engineering. By thoroughly understanding the role of the microenvironment, we can begin to correctly manipulate it to prevent and cure diseases through regenerative medicine techniques.

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Comparison of Different Acellular Dermal Matrices in Breast Reconstruction: The 50/50 Study

Abstract: Therapeutic, III.

Cited by 46 publications

References 37 publications

Identifying risk factors for postoperative major complications in staged implant‐based breast reconstruction with AlloDerm

Identifying risk factors for postoperative major complications in staged implant‐based breast reconstruction with AlloDerm

Latest Trends in Subpectoral Breast Reconstruction

Tissue specific microenvironments: a key tool for tissue engineering and regenerative medicine

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