Does Acellular Dermal Matrix Really Improve Aesthetic Outcome in Tissue Expander/Implant-Based Breast Reconstruction?

Ibrahim, Ahmed M. S.; Koolen, Pieter G. L.; Ganor, Oren; Markarian, Mark K.; Tobias, Adam M.; Lee, Bernard T.; Lin, Samuel J.; Mureau, Marc A.M.

doi:10.1007/s00266-015-0484-x

Cited by 63 publications

(53 citation statements)

References 44 publications

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“…The success in abdominal wall reconstruction has led to interest in using ECM‐derived materials in other reconstructive procedures, including eyelid, nasal, burn, lower extremity wounds, and breast . Significant strength is not the primary design criteria for these materials.…”

Section: Introductionmentioning

confidence: 99%

In vitroevaluation of decellularized ECM-derived surgical scaffold biomaterials

Luo

Kulig

Finkelstein

et al. 2015

J. Biomed. Mater. Res.

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Decellularized extracellular matrix (ECM) biomaterials are increasingly used in regenerative medicine for abdominal tissue repair. Emerging ECM biomaterials with greater compliance target surgical procedures like breast and craniofacial reconstruction to enhance aesthetic outcome. Clinical studies report improved outcomes with newly designed ECM scaffolds, but their comparative biological characteristics have received less attention. In this study, we investigated scaffolds derived from dermis (AlloDerm Regenerative Tissue Matrix), small intestinal submucosa (Surgisis 4-layer Tissue Graft and OASIS Wound Matrix), and mesothelium (Meso BioMatrix Surgical Mesh and Veritas Collagen Matrix) and evaluated biological properties that modulate cellular responses and recruitment. An assay panel was utilized to assess the ECM scaffold effects upon cells. Results of the material-conditioned media study demonstrated Meso BioMatrix and OASIS best supported cell proliferation. Meso BioMatrix promoted the greatest migration and chemotaxis signaling, followed by Veritas and OASIS; OASIS had superior suppression of cell apoptosis. The direct adhesion assay indicated that AlloDerm, Meso BioMatrix, Surgisis, and Veritas had sidedness that affected cell-material interactions. In the chick chorioallantoic membrane assay, Meso BioMatrix and OASIS best supported cell infiltration. Among tested materials, Meso BioMatrix and OASIS demonstrated characteristics that facilitate scaffold incorporation, making them promising choices for many clinical applications. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 585-593, 2017.

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Section: Introductionmentioning

confidence: 99%

In vitroevaluation of decellularized ECM-derived surgical scaffold biomaterials

Luo

Kulig

Finkelstein

et al. 2015

J. Biomed. Mater. Res.

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“…1,2 The use of ADM for IBBR is now widely accepted among reconstructive breast surgeons (utilization rates reported between 50% and 80%) owing to a number of advantages shown to be associated with its use. 3–7 The use of ADM is typically used in reconstructions involving thin, well-vascularized flaps. When elected, ADM is used during breast reconstruction for soft-tissue reinforcement and to provide coverage and support, supplement muscle coverage, and shape the breast and inframammary fold (IMF).…”

mentioning

confidence: 99%

“…3,6,11 ADM-assisted breast reconstruction can also allow for a prepectoral placement of the breast implant especially with advanced mastectomy techniques such as nipple sparing (NS). Before these advances, the expanders were traditionally placed in the submuscular pocket because of concerns with thin and poorly vascularized flaps.…”

mentioning

confidence: 99%

Complication Rates With Human Acellular Dermal Matrices: Retrospective Review of 211 Consecutive Breast Reconstructions

Schnarrs

Carman

et al. 2016

Plastic and Reconstructive Surgery - Global Open

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Background:Human acellular dermal matrix (HADM) is commonly used to provide coverage and support for breast reconstruction. The primary purpose of this study was to evaluate the complication rates associated with breast reconstruction procedures when performed in conjunction with multiple types of HADM in a consecutive series.Methods:After receiving institutional review board approval, medical records from a single surgeon were retrospectively reviewed for 126 consecutive patients (170 breasts and 211 procedures) who received a breast reconstruction or revision with implantation of HADM between 2012 and 2014. Patient demographics, surgical technique, and the complication profile of 4 major types of HADM were evaluated by procedure. Complication data were primarily evaluated for infection, seroma formation, necrosis, and other complications requiring additional surgery.Results:The total complication rate was 19.4%. The complication rates were not statistically different between all 4 types of HADM: Alloderm (n = 143); Alloderm RTU (n = 19); FlexHD (n = 18); hMatrix (n = 32) (P > 0.05). Smokers and large-breasted women (≥500 g) had a significantly higher complication rate than the rest of the population (P < 0.01 and P < 0.03, respectively). The complication rates associated with all other patient cohorts analyzed (age, body mass index, comorbid conditions, cancer diagnosis, prepectoral technique) showed no influence on complication rates (P > 0.05).Conclusions:In characteristically similar cohorts, there was no statistically significant difference in complication rates based on type of HADM; however, certain risk factors and anatomy should be considered before HADM-assisted breast reconstruction.

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“…Advantages of this technique include improved implant stabilization as well as a decrease rate of capsular contracture [1]. Furthermore, ADMs can be used for reconstruction of the inframammary fold (IMF) in order to achieve an improved aesthetic outcome [2]. …”

Section: Introductionmentioning

confidence: 99%

Evaluation of Complication Rates after Breast Surgery Using Acellular Dermal Matrix: Median Follow-Up of Three Years

Paprottka

Krezdorn

Sorg

et al. 2017

Plastic Surgery International

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Introduction Acellular dermal matrices (ADMs) are now commonly used for breast reconstruction surgery. There are various products available: ADMs derived from human (HADM), porcine (PADM), or bovine (BADM) sources. Detailed long-term follow-up studies are necessary to detect differences in complication rates between these products. Material and Methods From 2010 to 2015, forty-one patients underwent 52 ADM-breast reconstructions in our clinic, including oncologic breast reconstructions and breast augmentation revisions (n = 52). 15x HADMs (Epiflex®/DIZG), 21x PADMs (Strattice®/LifeCell), and 16x BADMs (Tutomesh®/RTI Surgical) were implanted. Retrospective data collection with median follow-up of 36 months (range: 12–54 months) was performed. Results Overall complication rate was 17% after ADM implantation (HADM: 7%; PADM: 14%; BADM: 31%). In a composite endpoint of complications and Red Breast Syndrome, a lower event probability was observed between BADMs, PADMs, and HADMs (44%, 19%, and 7%, resp.; p = 0.01 for the trend). Furthermore, capsular contracture occurred in 6%, more frequently as compared to the current literature. Conclusions When ADM-based reconstruction is indicated, the authors suggest primarily the use of HADMs and secondary the use of PADMs. It is shown that BADMs have the highest complication probability within our patient cohort; nevertheless, BADMs convey physical advantages in terms of flexibility and better aesthetic outcomes. The indication for the use of ADMs should be filled for each case individually.

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Does Acellular Dermal Matrix Really Improve Aesthetic Outcome in Tissue Expander/Implant-Based Breast Reconstruction?

Abstract: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Cited by 63 publications

References 44 publications

In vitroevaluation of decellularized ECM-derived surgical scaffold biomaterials

In vitroevaluation of decellularized ECM-derived surgical scaffold biomaterials

Complication Rates With Human Acellular Dermal Matrices: Retrospective Review of 211 Consecutive Breast Reconstructions

Evaluation of Complication Rates after Breast Surgery Using Acellular Dermal Matrix: Median Follow-Up of Three Years

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