Tissue Expansion after Non-Skin-Sparing Mastectomy: A Comparative Study of Expansion Courses of Prepectoral and Subpectoral Tissue Expander Placement with Acellular Dermal Matrix

Abstract

Although skin- or nipple-sparing mastectomy has been popular in the treatment of breast cancer, the radical excision of breast tissue is unavoidable in certain circumstances. However, the ability of an acellular dermal matrix (ADM) to expand remains questionable, and this situation may further hinder tissue expansion. From October 2017 to January 2020, patients who underwent immediate breast reconstruction with tissue expander placement using ADM whose initial fill volume was less than 50 mL were retrospectively reviewed. The primary outcomes were the number of visits and number of days required to complete the expansion, and the secondary outcomes were the amount of postoperative expansions, expander fill ratio and expander volume. Between the prepectoral group (n = 26) and subpectoral group (n = 39), the mean number of days (81.46 days versus 88.64 days, p = 0.365) and mean number of visits (5.08 versus 5.69, p = 0.91) required to complete expansion exhibited no significant differences. Additionally, there were no significant differences in the mean amount of postoperative expansion (314.23 mL versus 315.38 mL, p = 0.950), the mean final volume (353.08 mL versus 339.62 mL, p = 0.481) or the mean final volume ratio (0.89 versus 0.86, p = 0.35) between the two groups. Therefore, we suggest that prepectoral tissue expander placement after conventional mastectomy can be a valid option.

Pre-pectoral Breast Reconstruction: Surgical and Patient-Reported Outcomes of Two-Stages vs Single-Stage Implant-Based Breast Reconstruction

“…It is then possible to adapt the reconstruction in the second surgical time according to the new anatomical framework and the patient’s expectations. The subsequent expansion thus also allows for the use of larger implants that would have been contraindicated in a DTI reconstruction with prosthesis and ADM [ 33 ].…”

Prepectoral versus subpectoral two-stage implant-based breast reconstruction: U.S. medical center experience and narrative review

“…According to Sbitany and colleagues, the surgical time was prolonged with subpectoral expander placement compared to prepectoral device placement [4.3 (range, 3.5–4.8) versus 3.9 (3.3–4.3) hours, P=0.001] ( 30 ). Likewise, in Asian patients a prolonged surgical time with subpectoral expander placement compared to prepectoral has been reported (76.56 versus 58.46 minutes, P<0.001) ( 23 ). Remarkably, evaluating the prepectoral versus subpectoral technique with propensity score matching, authors from the University of Texas Southwestern Medical Center determined there was no associated change in surgical time implementing either one approach or the other (103 versus 104 minutes, P=0.891) ( 29 ).…”

“…Despite some studies have reported comparable rates of complications between prepectoral and subpectoral TE placement ( 19 - 23 ), other reports have highlighted that rates of complications differ depending on the plane of prosthesis placement for two-stage IBBR. Initial reports from Nahabedian and Cocilovo indicated that the percentage of patients who had surgical complications was 20.5% and 22% for the prepectoral and partial subpectoral cohorts, respectively ( 17 ).…”

“…In the study by Kraenzlin et al the operating room charges for prepectoral reconstruction were $31,276.8 compared to $22,231.8 in subpectoral TE placement (P<0.01) ( 27 ). The authors found that the associated use of large amounts of ADM in the prepectoral population generate higher costs ( 23 , 27 ). Further studies evaluating the impact of the number of postoperative clinic visits for expansion and the cost related to the management of major complications are necessary.…”

To acellular dermal matrix or not to acellular dermal matrix?—outcomes of pre-pectoral prosthetic reconstruction after nipple-sparing mastectomy with and without acellular dermal matrix

“…Previous studies have analyzed ADM use in immediate prosthetic reconstruction without controlling for plane of implant placement or solely analyzed outcomes by plane of implant placement without controlling for use of ADM ( 5 , 19 - 25 ). The existing reports analyzing ADM use in pre-pectoral breast reconstruction after NSM, are low powered, allowing for less accurate outcome profiles ( 26 - 30 ).…”