Immediate breast reconstruction using porcine acellular dermal matrix (Strattice™): Long-term outcomes and complications

https://doi.org/10.1016/j.bjps.2012.10.015Get rights and content

Summary

Background

There has been limited reported experience with the use of Strattice™ (LifeCell Corp., Branchburg, NJ), a porcine-derived acellular dermal matrix, in implant-based breast reconstruction. The purpose of this study is to evaluate our experience with this matrix.

Methods

Patients who underwent immediate single-stage or two-stage implant-based breast reconstruction with the assistance of Strattice were included in this study. Patient charts were reviewed for indications for mastectomy, adjunctive radiotherapy use, implant or expander volume, length of follow-up period, and type and incidence of complications during the follow-up period. Biopsies of Strattice were taken for histological analyses.

Results

A total of 105 reconstructions were performed in 54 patients: 77% were prophylactic and 23% were oncologic. All, but 4, reconstructions were single stage. Mean implant volume of single-stage reconstructions were 444.1 (range: 150–700 cc) and mean expander volume after completion of expansion was 400 (range: 350–450). Mean follow-up period was 41.3 months (range: 35.5–48.4 months). Total complication rate was 8.6%. Complications occurred in 9 breasts: implant loss or explantation (3.8%), infection (3.8%), skin breakdown or necrosis (2.9%), seroma (1.9%), implant exposure (1.0%), and delayed skin healing (1.0%). Histological analyses of implanted Strattice revealed a viable matrix with fibroblast infiltration and revascularization.

Conclusions

Over a mean 3.5-year follow-up period, low complication rates and good outcomes were observed with the use of Strattice that are comparable to those reported with human acellular dermal matrices.

Section snippets

Patients and methods

Patients who underwent immediate single-stage or two-stage implant-based breast reconstruction with the assistance of Strattice were included in this study. Patients who had undergone previous reconstructions and those who had implant-based flap procedures were excluded from the study. Breast reconstructions were performed between April 2008 and May 2009 in the authors' practice allowing for an adequate follow-up time period.

Strattice-assisted breast reconstruction was performed in the fashion

Results

A total of 54 patients met the inclusion criteria and were evaluated in this study. Approximately three-quarters of the patients had bilateral mastectomy (Table 1). Of the 105 reconstructions, 77% were prophylactic and 23% were oncologic. Six oncologic breasts were irradiated and 4 oncologic patients received chemotherapy. Almost all of the reconstructions were single stage, except for 4 which were two-staged. The mean implant volume of single-stage reconstructions was 444.1 ± 91.8 cc (range:

Discussion

Strattice is a porcine-derived acellular dermal matrix developed using the same principles as human ADM, AlloDerm® (LifeCell Corp., Branchburg, NJ). Additionally, it is processed to remove the galactose-α-(1,3)-galactose terminal disaccharide epitopes, believed to play a major role in xenogenic rejection response.13 Similar to human ADM, Strattice has been shown to revascularize, recellularize, remodel, and integrate into host tissue with no evidence of encapsulation, resorption, or

Funding

No funds were received or utilized for this research.

Conflict of interest

C Andrew Salzberg, MD, is a consultant for LifeCell Corporation. All other authors have no disclosure.

Acknowledgment

The authors like to thank LifeCell Corporation for editorial assistance.

References (30)

  • V. Bindingnavele et al.

    Use of acellular cadaveric dermis and tissue expansion in postmastectomy breast reconstruction

    J Plast Reconstr Aesthet Surg

    (2007)
  • E. Katerinaki et al.

    Histological appearance of Strattice tissue matrix used in breast reconstruction

    J Plast Reconstr Aesthet Surg

    (2010)
  • G.P. Maxwell et al.

    Use of the acellular dermal matrix in revisionary aesthetic breast surgery

    Aesthet Surg J

    (2009)
  • R. Gurunluoglu et al.

    Current trends in breast reconstruction: survey of American Society of Plastic Surgeons 2010

    Ann Plast Surg

    (2011 Aug 22)
  • S.T. Lanier et al.

    The effect of acellular dermal matrix use on complication rates in tissue expander/implant breast reconstruction

    Ann Plast Surg

    (2010)
  • C.A. Salzberg

    Nonexpansive immediate breast reconstruction using human acellular tissue matrix graft (AlloDerm)

    Ann Plast Surg

    (2006)
  • S.L. Spear et al.

    Acellular dermis-assisted breast reconstruction

    Aesthet Plast Surg

    (2008)
  • H. Sbitany et al.

    Acellular dermis-assisted prosthetic breast reconstruction versus complete submuscular coverage: a head-to-head comparison of outcomes

    Plast Reconstr Surg

    (2009)
  • K.R. Hanna et al.

    Comparison study of two types of expander-based breast reconstruction: acellular dermal matrix-assisted versus total submuscular placement

    Ann Plast Surg

    (2011 Aug 22)
  • K.H. Breuing et al.

    Immediate bilateral breast reconstruction with implants and inferolateral AlloDerm slings

    Ann Plast Surg

    (2005)
  • C.A. Salzberg et al.

    An 8-year experience of direct-to-implant immediate breast reconstruction using human acellular dermal matrix (AlloDerm)

    Plast Reconstr Surg

    (2011)
  • K.H. Breuing et al.

    Inferolateral AlloDerm hammock for implant coverage in breast reconstruction

    Ann Plast Surg

    (2007)
  • R.J. Zienowicz et al.

    Implant-based breast reconstruction with allograft

    Plast Reconstr Surg

    (2007)
  • J.D. Namnoum

    Expander/implant reconstruction with AlloDerm: recent experience

    Plast Reconstr Surg

    (2009)
  • H. Xu et al.

    A porcine-derived acellular dermal scaffold that supports soft tissue regeneration: removal of terminal galactose-α-(1,3)-galactose and retention of matrix structure

    Tissue Eng Part A

    (2009)
  • Cited by (91)

    • Breast reconstruction with silicone prosthesis and acellular dermal matrix of porcine origin: Retrospective study of 84 cases

      2022, Annales de Chirurgie Plastique Esthetique
      Citation Excerpt :

      In the literature, the results remained heterogenous. Recent studies have found prosthesis removal rates ranging from 8 to 20% on average [7,8,9,10]. This variability in rates may be related to the definition of the main inclusion criteria defined in each study; they were not always identical.

    View all citing articles on Scopus
    View full text