Muscle-Sparing ADM-Assisted Breast Reconstruction Technique Using Complete Breast Implant Coverage: A Dual-Institute UK-Based Experience

Abstract

Background: We report our early experience of a novel muscle-sparing breast (prepectoral) reconstruction technique using a pre-shaped Braxon® mesh (acellular dermal matrix) which completely wraps around the breast implant. Methods: All patients who underwent prepectoral implant-based breast reconstruction between April 2014 and September 2015 were included in the analysis. The dermal matrix Braxon® used is a pre-shaped matrix which forms a complete implant mesh wrap. The new breast created is placed over the chest wall without disturbing the pectoralis musculature. Results: A total of 51 (42 unilateral and 9 bilateral) muscle-sparing breast reconstructions were carried out. Complications included implant loss (n = 1; 1.7%) secondary to wound infection, seroma (n = 4; 6.7%), and superficial wound dehiscence (n = 1; 1.7%) which was re-sutured without further complication. The median follow-up period was 16.4 (range 8-25) months. Conclusion: The early experience appears highly satisfactory with good clinical outcome. The novel prepectoral implant-based breast reconstruction using the mesh wrap provides an effective alternative to the more traditional submuscular implant-based technique.

The Journey of Prepectoral Breast Reconstruction through Time

“…Interestingly, the implant loss rate decreases with the amount of mesh used to wrap the implant. While in full wrap cohort 10,13,14,16,19,21,24,26,28,32 , the rate ranges from less than 1%-18% , it decreases to 0-8% in the anterior/ partial cover 12,17,18,20,22,25,27,31 and it became even 0% in two studies where no mesh was used (total 47 patients) 15,23 . Of the full wrap studies, Downs et al, in their retrospective review of 45 patients (79 Alloderm or FlexHD assisted prepectoral implant-based breast reconstruction) correlate their implant loss rate of 18% to their learning curve and not objectively measuring tissue perfusion 10 .…”

The use of acellular dermal matrix in breast reconstruction: evolution of techniques over 2 decades

“…Reitsamer and Peintinger [2015] described porcine ADM use with shaped silicone gel-filled implants in primary prepectoral breast reconstruction following nipple-sparing mastectomy by employing a technique that involved extracorporeal suturing, trimming, and incisions of two sheets of ADM in order to create a fitted ADM envelope with angular ADM flaps that could be used to secure the implant in the prepectoral space (44). Additional reported techniques have involved suturing the anteriorly placed ADM to the periphery of the implant pocket, while other techniques involve partially or completely wrapping the implant with ADM secured with sutures either circumferentially, in a centromedial pattern on the posterior surface of the implant, or in a manufacture designed pattern prior to implant placement (45)(46)(47)(48)(49)(50)(51).…”

Prepectoral breast reconstruction with complete implant coverage using double-crossed acellular dermal matrixs

“…ADM-based dual-plane submuscular reconstruction has become the most widely used technique for immediate breast reconstruction with silicone implant after mastectomy because this new technique partially addresses the major limitation of the classical total submuscular technique, which is the inability to recreate natural-looking ptosis due to limited lower pole expansion of the pectoralis major muscle (PMM). Nonetheless, ADM-based dual-plane submuscular reconstruction cannot overcome all limitations of the traditional technique, including persistent pain from PMM dissection and coverage, prolonged drainage, hyperanimation deformity, blunting of the natural shape due to persistent pulling of the PMM, and limited reconstruction of severely ptotic breasts (6).…”