Inhibition Mechanism of Acellular Dermal Matrix on Capsule Formation in Expander–Implant Breast Reconstruction After Postmastectomy Radiotherapy

2019

Yeungnam Univ J Med

Implant-based breast reconstruction is the most commonly used reconstruction technique after mastectomy. This is because skin-sparing mastectomy has become possible with advancements in oncology. In addition, the development of breast implants and the advent of acellular dermal matrices have reduced postoperative complications and resulted in superior cosmetic results. The most frequently performed surgical breast reconstruction procedure for the past 20 years was the insertion of an implant under the pectoralis major muscle by means of the dual plane approach. However, some patients suffered from pain and animation deformity caused by muscle manipulation. Recently, a prepectoral approach has been used to solve the above problems in select patients, and the results are similar to subpectoral results. However, this technique is not always chosen due to the number of considerations for successful surgery. In this article, we will discuss the emergence of prepectoral breast reconstruction, indications and contraindications, surgical procedures, and outcomes.

Section: Historymentioning

confidence: 99%

Prepectoral breast reconstruction

2019

Yeungnam Univ J Med

“…In this study, there was no significant difference between the thickness of nonirradiated and irradiated ADM capsules. 2 Myofibroblasts and macrophages, which play central roles in tissue fibrosis, were significantly reduced in the ADM capsules compared with the subpectoral capsules. We first investigated the number of endothelial-mesenchymal transition (EndoMT) cells and vimentin positive fibroblasts, and the TGF-b1 and PDGF-B transcript levels in the capsular tissues.…”

Section: Presentmentioning

confidence: 89%

ASO Author Reflections: Acellular Dermal Matrix Reduces Myofibroblasts in Capsule Tissue

Jin

2018

Ann Surg Oncol

Self Cite

Capsular contracture is a major complication of implantbased breast reconstruction. Recent studies have shown that use of acellular dermal matrices (ADM) for coverage of breast implants decreased or prevented capsular contractures. Moyer et al. 1 performed histopathological analysis of native capsules and ADM capsules in both nonirradiated and irradiated patients. They observed significant differences in cellular infiltration and elastin distribution only. Other researchers have also investigated the histological differences between subpectoral and ADM capsules and the mechanism by which the ADM reduces capsule formation around the breast implant. However, the mechanism remains unclear.

“…As it functioned as a barrier between the mastectomy skin and the implant, ADM has made it possible to return to PBR. Kim et al reported that the levels of myofibroblasts were significantly lower in ADM capsules than in submuscular capsules [ 23 ]. With advances in oncologic surgical technique such as the NSM with optimal skin flap, improved implants, and ADMs, prepectoral breast reconstruction has become feasible.…”

Section: Discussionmentioning

confidence: 99%

A Comparative Analysis between Subpectoral versus Prepectoral Single Stage Direct-to-Implant Breast Reconstruction

Hong

2020

Medicina

Background and objectives: Until now subpectoral breast reconstruction (SBR) has been the predominant form; however, it can present with pectoralis muscle contraction and animation deformity. To avoid these complications, surgeons have begun placing breast implants in the same anatomic space as the breast tissue that was removed. We report a comparative analysis of prepectoral breast reconstruction (PBR) versus subpectoral breast reconstruction to analyze their differences. Materials and Methods: Direct-to-implant (DTI) reconstruction using acellular dermal matrix (ADM) performed from February 2015 to February 2020 were retrospectively reviewed. We then compared the clinical course and postoperative outcomes of the two groups (prepectoral vs. subpectoral) based on the overall incidence of complications, pain scale, and the duration of drainage. Results: A total of 167 patients underwent unilateral DTI, with SBR 114 (68.3%) and PBR 53 (31.7%). Patient demographics were similar between the two groups. There was no statistically significant difference in rates of seroma, infection (requiring intravenous antibiotics), hematoma, and skin necrosis. Implant loss rates in the SBR 6.1% (n = 7) and PBR 9.4% (n = 5) were also not statistically significant (p = 0.99). The hemovac duration period was significantly longer in the SBR (14.93 ± 5.57 days) group than in the PBR group (11.09 ± 4.82 days) (p < 0.01). However, post-operative pain scores are similar between two groups, although it is not clear whether this was due to the effect of postoperative patient-controlled analgesia. Conclusions: A SBR is a commonly used procedure with various advantages, but there are many problems due to damage to the normal pectoralis major muscle. According to the results of our study, the PBR group had a shorter hemovac duration period compared to the SBR group, although there was no significant difference in complication rate. A PBR is a simple and safe technique allowing early discharge without increasing the incidence of long-term complications.