Meshed Acellular Dermal Matrix in Immediate Prepectoral Implant-based Breast Reconstruction

Abstract

Background: Prepectoral implant placement has many potential advantages in immediate breast reconstruction. Acellular dermal matrices (ADMs) are commonly used in these surgeries. ADM meshing may enhance integration, decrease seroma and infection rates, and reduce surgical costs. Methods: This was a retrospective, single-center study of 49 women (71 breasts) undergoing immediate, prepectoral, implant-based breast reconstruction with 2:1 meshed, bovine-derived ADM (SurgiMend). Outcomes were compared against those of 77 patients (105 breasts) undergoing a similar procedure but with partial subpectoral implant placement. Results: In the prepectoral group, the mean age was 49.1 years and mean body mass index was 24.7 kg/m 2 . There were no significant differences in baseline characteristics versus the partial subpectoral control group. Mean follow-up was 18.6 months (prepectoral) and 21.3 months (partial subpectoral). Mean time to drain removal was reduced in the prepectoral group (6.5 versus 8.5 days; P < 0.001). Rates of minor and major complications with prepectoral implant placement were 15.5% and 11.3%, respectively – similar to partial subpectoral placement (15.2% and 14.3%) (overall P = 0.690). Capsular contracture and explantation were associated with radiation therapy, and rates were similar between groups. Conclusions: Prepectoral implant placement with meshed ADM is a safe and reproducible alternative to partial muscle coverage with meshed ADM. Recovery may be easier and animation deformity avoided. It could therefore become the standard of care for implant-based breast reconstruction.

Braxon®-assisted prepectoral breast reconstruction: A decade later

“…Studies currently available on PPBR and fenestrated ADMs seem to confirm this hypothesis. Compared with 2.1% CC incidences reported in the iBAG study ( 53 ) and the weighted mean of 2.06% in this study, which is calculated with the Braxon® continuous collagen sheet, fenestrated-ADM-assisted PPBRs outline higher CC incidences: out of 71 breasts, Scheflan et al found an incidence rate of 8.5% of CC ( 119 ), while in the same year, Fin et al recorded 6% ( 120 ). More recently, Wazir et al reported a 12.5% incidence rate ( 121 ).…”

Comparison of Human, Porcine, and Bovine Acellular Dermal Matrix in Prepectoral Breast Reconstruction

“…Four different reviewers performed title and abstract review. Full-text review was conducted for 355 articles; 33 studies were eligible and underwent data extraction 16,17,29–62 (Fig. 1).…”

A Nationwide Analysis Evaluating the Safety of Using Acellular Dermal Matrix with Tissue Expander-Based Breast Reconstruction

“… 21 It is speculated that the protective layer provided by the ADM between the implant and native tissue helps to slow the inflammatory process and limits the pathogenesis. However, with the growing popularity of meshing the matrix for better expansion and lower costs, 22 this ADM-assisted advantage in breast reconstruction may no longer exist. Currently, only one study by Maisel Lotan et al assessed fenestrated versus meshed ADM and found no differences in capsular contracture rates (2.7 vs. 5.2%; p = 0.342).…”