The use of porcine acellular dermal matrix in silicone implant-based breast reconstruction

Abstract

The use of PADM as an interface matrix for implant-based breast reconstruction yielded predictable and acceptable aesthetic and haptic results by preventing capsular contracture, rippling, implant malposition, soft-tissue thinning and failure of the silicone implant-based breast augmentation.

440 Consecutive Immediate, Implant-Based, Single-Surgeon Breast Reconstructions in 281 Patients

“…The published literature between 2005 and early 2012 reports 33 retrospective breast recon struction studies of reconstruction with acellular dermal matrix compared with 14 studies of reconstruction without acellular dermal matrix, 4,7,11,13,14,17,18,21,[25][26][27]38,45,46 14 studies of reconstruction with acellular dermal matrix alone, 1,2,[8][9][10]12,15,16,19,20,23,24,28,37 and five studies of reconstruction without acellular dermal matrix, 22,47-50 as summarized in an online supplement to this publication [see Table, Supplemental Digital Content 1, which shows a literature survey of breast reconstructions using acellular dermal matrices as compared with reconstructions with matrices (2005 to early 2012), http://links.lww.com/PRS/A700; note that disclosures are as written in original articles at time of publication and may not reflect current disclosure status of authors]. These studies vary in size and evidential value, but are indeed those same studies that have been influential in the adoption and ever-increasing use of acellular dermal matrices in breast reconstruction.…”

“…[29][30][31][32][33][34][35][36] Fewer cases have been reported in the literature describing breast reconstruction using xenogenic acellular dermal matrices. 37,38 The individual studies differ in finding either little or no difference, an increase, or a decrease in complication rates with acellular dermal matrix use in breast reconstruction, as compared with use of no acellular dermal matrix. Not surprisingly, the meta-analyses also mirror this disagreement, with diverging conclusions on the effect of acellular dermal matrix use in breast reconstruction on complication rates.…”

Porcine-derived acellular dermal matrix in primary augmentation mammoplasty to minimize implant-related complications and achieve an internal mastopexy: a case series

“…The current findings supplement those of this earlier study and suggest that PADM also may be used in similar patients who wish to undergo breast implant surgery. ADMs are likely to be of particular value in such patients because they provide a connective tissue matrix to reinforce weakened tissues, limit tension on the skin envelope, and successfully support an implant [14,23,30]. …”

“…Acellular dermal matrices (ADMs) have been used widely in prosthetic breast reconstruction [14-16] and in revision of cosmetic breast surgery [17,18]. Among the most widely used of these is a non-crosslinked intact porcine-derived ADM (PADM; Strattice™ Reconstructive Tissue Matrix, LifeCell Corp., Branchburg, NJ, USA), which serves as a scaffold for the ingrowth of host cells, collagen, and blood vessels.…”

“…Moreover, some investigators have reported an increased risk of certain complications with ADMs in the context of breast reconstruction, including infection and reconstruction failure, but a lower rate of capsular contracture; however, it is not yet known whether different ADMs pose different levels of risk [19]. Regardless, to date only a small number of published reports have described the successful use of ADMs in primary cosmetic breast procedures to create ‘internal bras’ in patients with skin of poor quality or evidence of ligamentous support failure undergoing mastopexy, either alone or paired with breast reduction [8,14]. By contrast, women with poor quality soft-tissue support seeking breast augmentation are widely considered at increased risk for a poor long-term outcome [8].…”