Prepectoral Breast Reconstruction

Graziano, Francis D.; Lu, Jocelyn; Sbitany, Hani

doi:10.1016/j.cps.2022.09.004

Cited by 4 publications

(2 citation statements)

References 38 publications

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“…In this context, prepectoral reconstruction regained a new life, and it represents the first option in many breast units for selected patients [ 20 , 26 , 27 ]. The main limitation is the cost of ADMs, but the advantages are clear.…”

Section: Discussionmentioning

confidence: 99%

“…Usually, four resorbable sutures (Vicryl 2/0) are prepared and fixed to the ADM (leaving the suture thread long and with the needle attached) at 2, 4, 8, and 10 o’clock. The mammary pocket is then washed with a triple Betadine solution [ 26 ]. Thus, the ADM implant coated and loaded with these sutures is placed in the pocket, and the patient is placed in a sitting position with the arm adducted.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Optimizing Acellular Dermal Matrix Integration in Heterologous Breast Reconstructive Surgery: Surgical Tips and Post-Operative Management

Caputo,

Scarabosio,

Di Filippo

et al. 2023

Medicina

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Background and Objective: Prepectoral implant placement in breast reconstruction is currently a must-have in the portfolios of breast surgeons. The introduction of new tools and conservative mastectomies is a game changer in this field. The prepectoral plane usually goes hand-in-hand with the ADM wrapping of the implant. It is a cell-free dermal matrix comprising a structurally integrated basement membrane complex and an extracellular matrix. The literature reports that ADMs may be useful, but proper patient selection, surgical placement, and post-operative management are essential to unlock the potential of this tool, as these factors contribute to the proper integration of the matrix with surrounding tissues. Materials and Methods: A total of 245 prepectoral breast reconstructions with prostheses or expanders and ADMs were performed in our institution between 2016 and 2022. A retrospective study was carried out to record patient characteristics, risk factors, surgical procedures, reconstructive processes, and complications. Based on our experience, we developed a meticulous reconstruction protocol in order to optimize surgical practice and lower complication rates. The DTI and two-stage reconstruction were compared. Results: Seroma formation was the most frequent early complication (less than 90 days after surgery) that we observed; however, the majority were drained in outpatient settings and healed rapidly. Secondary healing of wounds, which required a few more weeks of dressing, represented the second most frequent early complication (10.61%). Rippling was the most common late complication, particularly in DTI patients. After comparing the DTI and two-stage reconstruction, no statistically significant increase in complications was found. Conclusions: The weakness of prepectoral breast reconstruction is poor matrix integration, which leads to seroma and other complications. ADM acts like a graft; it requires firm and healthy tissues to set in. In order to do so, there are three key steps to follow: (1) adequate patient selection; (2) preservative and gentle handling of intra-operative technique; and (3) meticulous post-operative management.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%