Immediate post-mastectomy prepectoral breast reconstruction with animal derived acellular dermal matrices: A systematic review

Tellarini, Annachiara; Garutti, Leonardo; Corno, Martina; Tamborini, Federico; Paganini, Ferruccio; Fasoli, Veronica; Di Giovanna, Danilo; Valdatta, Luigi

doi:10.1016/j.bjps.2023.08.020

Cited by 3 publications

(5 citation statements)

References 56 publications

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“…Some authors [2,13,[33][34][35][36][37] suggest that most of the studies conducted on the effect of an ADM in the postoperative results were made with AlloDerm ® , which is a product that has been sold for longer, and only more recently, a series has been published with the use of other ADM, both from human and porcine origin, and although the preparation is similar in removing the cellularity of the tissue and infectious organisms, there may be subtle unpublished differences in the processing and storage of these products, causing an inflammatory response with a higher influence in the formation of seroma that could also be related to the increase in other complications such as infections or extrusions of the implant [34]. Reference is also made to important immunological differences between the matrices of human or non-human origin that can influence the rate of complications, preventing extrapolation of results from different studies [14,35,[38][39][40]. Other works consider that the fact that there is not a unanimous criterion defining the concept of seroma or infection could also influence the different results, since clinical signs can be interpreted differently.…”

Section: Analysis Of Resultsmentioning

confidence: 99%

Single-Stage Immediate Breast Reconstruction with Acellular Dermal Matrix after Breast Cancer: Comparative Study and Evaluation of Breast Reconstruction Outcomes

Dueñas-Rodríguez,

Navarro-Cecilia,

Luque-López

et al. 2023

Cancers

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We evaluate postoperative complications, aesthetic results and satisfaction outcomes in patients with breast cancer after intervening with a skin-sparing or nipple-sparing mastectomy with an immediate prosthetic reconstruction with or without a biological mesh. Patients with multifocal breast cancer, ductal carcinoma in situ with an indication for a mastectomy and cT2 tumors with no response to primary systemic treatment were included, whereas patients aged >75 years, with inflammatory carcinoma, and severe circulatory disorders were excluded. Patients in the control group were reconstructed using a prosthesis, whereas the study group included patients reconstructed using a prosthesis and biological acellular porcine dermal mesh (Strattice™). In both groups, the result was assessed using the BREAST-Q instrument. A total of 51 patients (62 intervened breasts) were included in the study group and 38 patients (41 intervened breasts) in the control group. Implant loss and removal occurred in three patients in the study group (5.9%) and nine patients in the control group (24.3%; p = 0.030). Infections appeared in three patients in the study group (4.8%) and three patients in the control group (7.3%; p = 1.00). Skin necrosis appeared in 5 patients in the study group (12.2%) and 11 patients in the control group (21.6%; p = 0.367). Seroma appeared in five patients in the study group (12.2%) and five patients in the control group (8.1%; p = 0.514). The BREAST-Q questionnaire is a comparison between both groups regarding “satisfaction with breasts after surgery” (p = 0.026), “sexual well-being after intervention” (p = 0.010) and “satisfaction with the information received” (p = 0.049). We have noted a statistically significant decrease in implant loss in women receiving an implant with a biological mesh. A higher satisfaction was observed in patients reconstructed using Strattice™, with statistically significant differences in three items.

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Section: Analysis Of Resultsmentioning

confidence: 99%

Single-Stage Immediate Breast Reconstruction with Acellular Dermal Matrix after Breast Cancer: Comparative Study and Evaluation of Breast Reconstruction Outcomes

Dueñas-Rodríguez,

Navarro-Cecilia,

Luque-López

et al. 2023

Cancers

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“…The extent of ADM implant coverage is still debated. In our practice, an ADM for complete prosthesis wrap was opted, as mechanical and anti-fibrotic abilities of ADMs have been extensively demonstrated and involving the entire synthetic surface could maximize their action ( 38 , 39 ). Several clinicians have already adopted this strategy, making use of human dermal matrices ( 21 , 22 , 25 , 38 ).…”

Section: Discussionmentioning

confidence: 99%

Pre-pectoral breast reconstruction with tissue expander entirely covered by acellular dermal matrix: feasibility, safety and histological features resulting from the first 64 procedures

Bernini,

Gigliucci,

Cassetti

et al. 2024

Gland Surg

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Background Reconstructive options that can be used following conservative mastectomy, skin-, nipple-sparing and skin-reducing mastectomies, allow a remarkable variety of safe methods to restore the natural shape and aesthetics of the breast mound. In case of two-stage breast reconstruction, tissue expanders (TEs) are usually placed in a subpectoral position. The purpose of this retrospective cohort study is to evaluate the feasibility and safety of two-step reconstruction with TE in pre-pectoral position covered by acellular dermal matrix (ADM). Methods Between March 2021 and May 2023, at the Azienda Ospedaliero Universitaria Careggi, University of Florence, 55 patients with BRCA 1/2 mutations or early breast cancer underwent conservative mastectomy with immediate pre-pectoral reconstruction using TE covered with ADM, followed by a second surgery with replacement of the expander with definitive prosthesis. Demographic, oncological, and histological data along with surgical complications were recorded. Results A total of 64 conservative mastectomies were performed. In 2 patients (3.1%) complications were found that required reintervention and, in both cases, the TE had to be removed. Two patients developed hematoma and one patient developed seroma. Two patients showed wound dehiscence, both healed after conservative treatment and without implant exposure. No case of necrosis of the skin or nipple-areola complex has been observed, neither of capsular contracture. Capsule formed around TE was populated with cells and blood vessels and showed a thin area of synovial metaplasia. Conclusions In selected cases it may be more cautious to perform a two-stage breast reconstruction after radical breast surgery by means of TEs. The placement of TEs in pre-pectoral position combines the excellent aesthetic and functional results of the pre-pectoral philosophy with a quite safer and more prudent two-step approach. Our experience reports optimistic results: the ADM covering the TE is seen successfully integrating during tissue expansion and becoming a vascularised new self-tissue. Complications rates are low and such ADM-assisted two-stage pre-pectoral reconstructive technique is a safe, practical, and reproducible method.

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“…This variety allows surgeons to select the most suitable ADM based on the patient’s specific needs and preferences. Furthermore, these ADMs can be further categorized based on their meshed or fenestrated structure, each having its unique characteristics and properties [ 7 , 32 ].…”

Section: Prepectoral Breast Reconstruction With Biological Meshesmentioning

confidence: 99%

“…In a study conducted by Tellarini et al, it was found that individuals undergoing ADM-assisted prepectoral breast reconstruction are more prone to complications if they smoke, undergo adjuvant radiotherapy or axillary lymph node dissection, or have a larger breast volume. The relationship between diabetes, high BMI, and breast implant size as potential risk factors is still a topic of debate [ 32 ].…”

Section: Prepectoral Breast Reconstruction With Biological Meshesmentioning

confidence: 99%

“…However, the utilization of acellular dermal matrices (ADMs) has been under consideration even in patients who are at a heightened risk for complications, such as patients undergoing post-mastectomy radiation therapy (PMRT), who are susceptible to the development of capsular contracture [ 32 , 59 , 60 ]. Moreover, in a study conducted by Polotto et al in the year 2023, this retrospective analysis encompassed a sample size of 485 patients, with 439 individuals undergoing ADM-assisted prepectoral breast reconstruction (PPBR).…”

Section: Prepectoral Breast Reconstruction and Impact Of Radiotherapymentioning

confidence: 99%

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Current Global Trends in Prepectoral Breast Reconstruction

Taj,

Chandavarkar,

Vidya

2024

Medicina

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Implant-based breast reconstruction (IBBR) is the most frequently performed procedure for breast reconstruction following mastectomy, which involves the surgical placement of breast implants. The approach to breast reconstruction can be divided into two main categories, namely prepectoral breast reconstruction (PPBR) and subpectoral breast reconstruction (SPBR), based on the implant plan and placement technique. In recent years, there has been a significant surge in the popularity of prepectoral implant-based breast reconstruction, where the implants are positioned above the chest muscle, as opposed to beneath it in the subpectoral approach. However, despite this growing preference, there is a lack of comprehensive data regarding the national trends in the utilization of this technique, thus necessitating further investigation. This narrative review aims to ascertain the current global patterns linked to prepectoral breast reconstruction and elucidate the considerations surrounding patient and implant selection, reconstructive techniques, the utilization of meshes in prepectoral reconstruction, the ensuing outcomes and complications, the ramifications of radiotherapy, and the potential advantages of integrating fat infiltration into the implementation of this technique in breast reconstruction with a focus on published papers in last five years. Conclusion: Prepectoral breast reconstruction has emerged as an appropriate surgical option for individuals seeking breast reconstruction. This development can be attributed to the recent progress made in implant technology, which has significantly enhanced the outcomes of this procedure. Additionally, advancements in mastectomy techniques, autologous fat grafting, and the use of acellular dermal matrices (ADMs) have also played a vital role in improving the aesthetic results of prepectoral breast reconstruction. As a result, the significance and effectiveness of this technique in the field of breast reconstruction have been firmly established, making it an essential component of the overall armamentarium available to plastic surgeons for breast reconstruction purposes.

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Immediate post-mastectomy prepectoral breast reconstruction with animal derived acellular dermal matrices: A systematic review

Cited by 3 publications

References 56 publications

Single-Stage Immediate Breast Reconstruction with Acellular Dermal Matrix after Breast Cancer: Comparative Study and Evaluation of Breast Reconstruction Outcomes

Single-Stage Immediate Breast Reconstruction with Acellular Dermal Matrix after Breast Cancer: Comparative Study and Evaluation of Breast Reconstruction Outcomes

Pre-pectoral breast reconstruction with tissue expander entirely covered by acellular dermal matrix: feasibility, safety and histological features resulting from the first 64 procedures

Current Global Trends in Prepectoral Breast Reconstruction

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