The Effect of Biological Scaffold (Biodesign) in Postmastectomy Direct-to-Implant Breast Reconstruction

Abstract

Background: Direct-to-implant (DTI) breast reconstruction is one of the immediate implant-based breast reconstruction methods. If the amount of soft tissue (eg, muscle or fascia) is insufficient to completely cover the implant, biological scaffold or acellular dermal matrix can be safely used for implant coverage. In this study, we used an acellular porcine small intestinal submucosa (SIS) mesh (Biodesign; Cook Medical Inc, Bloomington, IN) for DTI reconstruction to explore the impact of its use on breast reconstruction results. Methods: We retrospectively assessed cases involving DTI reconstruction at Taipei Veterans General Hospital from 2015 to 2019. Women, 18 years or older, who underwent immediate DTI reconstruction after mastectomy were included in the study. Mastectomy may have been performed because of therapeutic or prophylactic reasons. Patients who did and did not use SIS mesh for reconstruction were studied separately, and the 2 groups were compared in terms of clinical outcomes and complications. The validated, self-administered BREAST-Q Reconstruction Module version 2.0 survey was used to evaluate health-related quality of life and satisfaction among patients who underwent breast reconstruction. Results: A total of 30 DTI breast reconstructions were enrolled. The mean age was 49.2 years, and the mean body mass index was 22.3 kg/m 2 . The mean postoperative follow-up duration was 17.1 months. Nipple-sparing mastectomy was performed for 26 cases (86.7%), and DTI breast reconstructions using SIS mesh for implant coverage were done in 14 cases (46.7%). The overall complication rate was 53.3% in 30 reconstructions, with nipple complications being the most common complication. The non-SIS and SIS-using groups had a similar overall complication rate postoperatively. As for the quality-of-life assessment, the SIS group obtained a higher score on BREAST-Q than those for whom SIS was not used. Conclusions: Porcine SIS mesh might be a safe and effective alternative to biological scaffolds in immediate 1-stage implant-based breast reconstruction to improve the quality of life after surgery.

Promotion of diced cartilage survival and regeneration with grafting of small intestinal submucosa loaded with urine‐derived stem cells

“… 24 , 25 In recent years, the SIS has been widely used in tissue regeneration engineering and clinical trials for bladder repairing, 26 gastric ulcer repairing, 27 inguinal hernia repairing 28 and breast reconstruction. 29 These studies have confirmed that the SIS possessed great biocompatibility and safety, as well as ability to promote tissue regeneration in vivo, which is essential for diced cartilage grafting. Moreover, the SIS has also been used for cartilage‐related repair and regeneration such as tracheal cartilage regeneration, 30 , 31 meniscal cartilage repairing, 32 , 33 , 34 upper airway regeneration 35 and rheumatoid arthritis repairing.…”

“…Small intestinal submucosa (SIS), as a natural decellularised biomaterial consisting of collagen and various growth factors, could promote tissue regeneration, angiogenesis and immunoregulation 24,25 . In recent years, the SIS has been widely used in tissue regeneration engineering and clinical trials for bladder repairing, 26 gastric ulcer repairing, 27 inguinal hernia repairing 28 and breast reconstruction 29 . These studies have confirmed that the SIS possessed great biocompatibility and safety, as well as ability to promote tissue regeneration in vivo, which is essential for diced cartilage grafting.…”

Extracellular matrix scaffold-assisted tumor vaccines induce tumor regression and long-term immune memory

“…Decellularized porcine small intestinal submucosa (SIS) ECM was prepared for use as an archetypical ECM scaffold biomaterial and cryogenically milled into an injectable particulate ( Fig 1A ). SIS was selected because it has been extensively studied in soft tissue repair in both pre-clinical and clinical models, including in cancer treatment [7, 8, 25, 26]. An injectable formulation permits minimally invasive localized delivery and avoids the trauma of surgical implantation thus isolating the host response to the ECM scaffold itself ( Fig 1B ).…”

“…Extracellular matrix (ECM) scaffolds are medical devices derived from decellularized mammalian tissues that are increasingly used biomaterials in cancer care, where they are implanted in patients during reconstructive surgeries immediately following tumor resection [4][5][6][7][8]. ECM scaffolds are immunomodulatory but generate an immune environment that is entirely distinct from the foreign body reaction generated by many synthetic, polymeric scaffold materials.…”

National Trends in Acellular Dermal Matrix Utilization in Immediate Breast Reconstruction

“…Plastic and Reconstructive Surgery • January 2024 26e majority of these articles report on retrospective single-center studies with relatively small sample sizes. 3,[16][17][18][19][20] Given the heterogeneity of institution practices, it is difficult to draw concrete conclusions regarding ADM use from these studies. The National Surgical Quality Improvement Program (NSQIP) database is a widely accepted and validated data set that is endorsed by the American College of Surgeons (ACS).…”