Evidence for the Use of Acellular Dermal Matrix in Implant-Based Breast Reconstruction

Abstract

Acellular dermal matrices (ADMs) are tissue grafts that have been specially processed to remove all cellular components. These machined biological scaffolds have become popular in a variety of surgical settings due to their rapid incorporation into living tissue. As ADMs are highly malleable and cause minimal inflammation, they have come to serve as a useful tool in implant-based breast reconstruction procedures. The major benefits of using an ADM in this setting include superior initial breast contouring, decreased risk of capsular contracture after implant insertion, and consistent sustained positioning of the reconstructed breast. Despite these advantages, these tissue grafts are foreign to the host, and postoperative complications following ADM insertion, including infection and seroma, have been well documented. When considering using ADMs in this setting, it is important to first consider patient-specific factors that could preclude their use, such as low body mass index, small breasts, or a history of radiation exposure to the breast tissue. ADM grafts are also expensive, which may present another barrier to their use. Review of the literature ultimately suggests a continued role for ADMs in implant-based breast reconstruction, and continued research in this field is warranted.

Submuscular and Pre-pectoral ADM Assisted Immediate Breast Reconstruction: A Literature Review

“…The main disadvantage of this kind of procedure is the high costs, as shown by Gravina et al [ 24 ]. They analyzed the different characteristics of the main ADMs and their alternatives, underlining the good aesthetic outcomes and the benefits of single-stage procedures, but these aspects are balanced with high costs and an increased risk of infection and overall surgical complication [ 24 ].…”

“…Immediate breast reconstruction (IBR) received an important boost in popularity as a consequence of the advent of ADMs [ 2 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. The use of ADMs showed encouraging results but conflicting reports as well [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ]. ADMs-assisted breast reconstruction can be divided into pre-pectoral and submuscular.…”

Acellular Dermal Matrix in Prosthetic Breast Reconstructive Surgery with Prepectoral Technique: A Literature Review

“…Acellular dermal matrices (ADMs) have been recently introduced to avoid direct contact between silicone implants and host tissues, in order to decrease capsular contracture rates [24,26]. In particular, acellular bovine pericardium-derived collagen matrix membranes (APMs) have been used in immediate-breast reconstruction, improving the definition of the inframammary and lateral mammary fold and reducing capsular contracture [27].…”

Impact of radiation dose on complications among women with breast cancer who underwent breast reconstruction and post-mastectomy radiotherapy: A multi-institutional validation study

“…Although efforts have been made in the field of surgery (e.g., microsurgical techniques and using an acellular dermal matrix) to reduce complications and improve patient satisfaction, the PMRT schedule has not changed much in the past decade (50 Gy using conventional fractionation) [11]. However, advances in RT technology supporting precise conformal RT and a greater understanding of breast cancer biology have diversified radiation treatments, from beam delivery to fractionation schedules.…”