Journal of Plastic, Reconstructive & Aesthetic Surgery
Immediate breast reconstruction with acellular dermal matrix: Factors affecting outcome
Introduction
Over the past decade, the use of acellular dermal matrix (ADM) in immediate implant-based breast reconstruction has gained acceptance. Currently, half of all implant-based reconstructions are performed with the use of an ADM.1 The reported benefits of using human ADM (HADM) include better aesthetic outcome due to better control of the inframammary fold and coverage of the implant,2, 3 creation of a larger implant pocket allowing for single-stage reconstruction,4, 5, 6, 7, 8, 9, 10, 11 and possible decrease in capsular contracture.2, 3, 10, 12, 13, 14
The majority of the evidence base for the use of ADM in breast reconstruction lies with human ADMs and particularly AlloDerm® (LifeCell Corp., Branchburg, NJ, USA).2, 4, 6, 10, 12, 15, 16, 17, 18 However, a number of other nonhuman ADMs, derived from bovine pericardium, bovine dermis, porcine dermis, and porcine small intestinal submucosa, are now available and are used in a similar capacity as human ADMs in breast reconstruction. Published experience with theses matrices is, however, limited and highlights a need to evaluate their efficacy and safety before widespread adoption.14, 19, 20, 21, 22, 23 The aim of this study was to report our early outcome using Strattice™ (LifeCell Corp., Branchburg, NJ, USA), a porcine ADM, in immediate implant-based breast reconstruction with particular emphasis on technique adaptations and learning curves that may influence outcomes.
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Patients and methods
All patients who underwent Strattice-assisted implant-based breast reconstructions at Guy's and St. Thomas' Hospitals, London, and at Clinic Pyramide, Zürich, from December 2008 to October 2012 were retrospectively reviewed. Single-stage reconstruction was offered unless there was concern with skin viability or when patient had opted for simultaneous augmentation; in these cases, a two-stage procedure was performed.
Mastectomy was performed via a skin-sparing or nipple-sparing approach by breast
Results
A total of 149 patients with a mean age of 48 years (range: 27–76 years) who underwent 200 immediate Strattice-assisted implant-based breast reconstruction following a skin-sparing (n = 163) or nipple-sparing (n = 37) mastectomy were included in this study. Patient demographic data are summarized in Table 1.
After reconstructive surgery, patients were followed up for a mean of 22.2 months (range: 1.6–48.1 months). Early complications occurred in 65 breasts for an overall complication rate of
Discussion
Our institutional experience with Strattice-assisted implant-based breast reconstruction was associated with an early total complication rate of 32.5% which is two to five times higher than those in previously published studies involving the use of Strattice (6.3–16.9%, Table 9).14, 20, 21, 25 The seroma (10.5% vs. 1.4–5.2%), hematoma (5% vs. 0–1.5%), infection (11.5% vs. 2.1–10.4%), and implant loss (12.5% vs. 1.4–13%) rates in this study were most notably higher. Additionally, our rates were
Conflict of interest
Alessia M. Lardi, MD, received an educational grant (LifeCell Corporation). All other authors have no disclosure. No funds were received or utilized for this research. Ethic approval was not required for this study.
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2023, Journal of Plastic, Reconstructive and Aesthetic SurgeryRisk of major postoperative complications in breast reconstructive surgery with and without an acellular dermal matrix: A development of a prognostic prediction model
2022, JPRAS OpenCitation Excerpt :As a result, risk factors that were added later in the registry such as smoking status, body mass index, and implant volume were not yet suitable for admission in the prediction model due to the lack of statistical power.22,24 While recent studies suggest that these factors may play a major role in the risk of postoperative complications in SSBR.39,40 In addition, there is insufficient information on the types of ADM that were used, as this factor was also added to the DBIR in September 2017.
Biological and synthetic mesh assisted breast reconstruction procedures: Joint guidelines from the Association of Breast Surgery and the British Association of Plastic, Reconstructive and Aesthetic Surgeons
2021, European Journal of Surgical OncologyCitation Excerpt :The study reported high rates of implant loss (9%), infection (25%), readmission (18%) and reoperation (18%) within 3 months of reconstructive surgery in all groups, irrespective of the use or type of mesh [4]. Complications rates were associated with smoking, high body mass index (BMI), longer operative time and previous radiotherapy, consistent with previously published studies [22–25]. This highlights the importance of careful patient selection in combination with meticulous perioperative practice [22,26] to optimise outcomes for patients undergoing mesh-assisted IBR procedures.
A systematic review and meta-analysis on the effect of neoadjuvant chemotherapy on complications following immediate breast reconstruction
2021, BreastCitation Excerpt :Hematomas, seromas, and wound complications are all factors which may not directly cause failure of reconstruction but may delay administration of adjuvant therapy. Nine of the 14 studies evaluated in this meta-analysis showed non-significant trends towards increased minor complications among women who had received NACT [19,21,22,24,28–30,32,33]. This is supported by the findings of Mehrara et al., who looked at 952 women of whom 70 had NACT prior to immediate reconstructions [42].