scholarly journals Outcome of complete acellular dermal matrix wrap with polyurethane implant in immediate prepectoral breast reconstruction

2020 ◽  
Vol 47 (6) ◽  
pp. 567-573
Author(s):  
Foteini Naemonitou ◽  
Senthurun Mylvaganam ◽  
Fathi Salem ◽  
Raghavan Vidya
Keyword(s):  
Breast Reconstruction ◽  
Wound Dehiscence ◽  
Acellular Dermal Matrix ◽  
Late Complications ◽  
Long Term Results ◽  
Complication Rates ◽  
Dermal Matrix ◽  
Satisfactory Outcome ◽  
Observational Series ◽  
Acellular Dermal

Background Polyurethane implants have been used on and off in breast reconstruction since 1991 while prepectoral breast reconstruction has gained popularity in recent times. In this study, we present our outcomes from the use of acellular dermal matrix (ADM) complete wrap with polyurethane implants in prepectoral breast reconstruction.Methods This is a retrospective review of prospectively maintained database from 41 patients receiving complete ADM wrap with prepectoral polyurethane implants over a 3-year period. Selection criteria were adapted from a previous study (4135 Trust Clinical Audit Database) evaluating prepectoral reconstruction with Braxon matrices. Patient demographics, operative data, surgical complications, and outcomes were collected and analyzed.Results A total of 52 implant reconstructions were performed in 41 patients with a mean follow-up of 14.3 months (range, 6–36 months). The overall reported complication rates including early (less than 6 weeks) and late complications. Early complications included two patients (4.9%) with wound dehiscence. One of which had an implant loss that was salvageable. Another patient (2%) developed red-breast syndrome and two women (4.9%) developed with seroma treated conservatively. Late complications included one patient (2%) with grade II capsular contraction, 12 patients with grade I-II rippling and two patients (4.9%) with grade III rippling.Conclusions We present our experience of prepectoral polyurethane implant using complete ADM wrap. This is one of the few papers to report on the outcome of the prepectoral use of polyurethane in immediate implant-based breast reconstruction. Our early observational series show satisfactory outcome and long-term results are warranted by a large multicenter study.

scholarly journals Does Acellular Dermal Matrix Thickness Affect Complication Rate in Tissue Expander Based Breast Reconstruction?

2016 ◽  
Vol 2016 ◽  
pp. 1-6
Author(s):  
Jessica F. Rose ◽  
Sarosh N. Zafar ◽  
Warren A. Ellsworth IV
Keyword(s):  
Breast Reconstruction ◽  
Skin Necrosis ◽  
Tissue Expander ◽  
Retrospective Chart Review ◽  
Acellular Dermal Matrix ◽  
Complication Rates ◽  
Dermal Matrix ◽  
Drain Removal ◽  
Dermal Matrices ◽  
Acellular Dermal

Background. While the benefits of using acellular dermal matrices (ADMs) in breast reconstruction are well described, their use has been associated with additional complications. The purpose of this study was to determine if ADM thickness affects complications in breast reconstruction. Methods. A retrospective chart review was performed including all tissue expander based breast reconstructions with AlloDerm (LifeCell, Branchburg, NJ) over 4 years. We evaluated preoperative characteristics and assessed postoperative complications including seroma, hematoma, infection, skin necrosis, and need for reintervention. We reviewed ADM thickness and time to Jackson-Pratt (JP) drain removal. Results. Fifty-five patients underwent 77 ADM-associated tissue expander based breast reconstructions, with average age of 48.1 years and average BMI of 25.9. Average ADM thickness was 1.21 mm. We found higher complication rates in the thick ADM group. Significant associations were found between smokers and skin necrosis (p<0.0001) and seroma and prolonged JP drainage (p=0.0004); radiated reconstructed breasts were more likely to suffer infections (p=0.0085), and elevated BMI is a significant predictor for increased infection rate (p=0.0037). Conclusion. We found a trend toward increased complication rates with thicker ADMs. In the future, larger prospective studies evaluating thickness may provide more information.

scholarly journals Outcome Assessment According to the Thickness and Direction of the Acellular Dermal Matrix after Implant-Based Breast Reconstruction

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Joon Hur ◽  
Hyun Ho Han
Keyword(s):  
Postoperative Complications ◽  
Breast Reconstruction ◽  
Surgical Outcomes ◽  
Acellular Dermal Matrix ◽  
Demographic Variables ◽  
Matrix Group ◽  
Complication Rates ◽  
Related Factors ◽  
Dermal Matrix ◽  
Acellular Dermal

Purpose. The acellular dermal matrix plays an important role in reinforcing thin mastectomy skin and repositioning the implant in prosthetic breast reconstruction. As the concept of prepectoral plane has become widespread, the role of the acellular dermal matrix has become increasingly important. However, evidences and standards for appropriate thickness and direction during placement remain insufficient. This study is aimed at testing the assumption that differences in the acellular dermal matrix thickness and orientation during placement may affect surgical outcomes including the incidence of postoperative complications. Methods. This was a retrospective single-centered analysis of 43 patients (50 breasts) who underwent implant-based reconstruction with MegaDerm® (L&C Bio, Seoul, Korea) and 23 patients (23 breasts) who underwent implant-based reconstruction with DermACELL® (LifeNet Health, Virginia Beach, VA, USA), two types of human-derived acellular dermal matrix. All surgeries were performed by a single surgeon. Demographic variables, surgery-related factors, and complications were compared between a thick matrix group (1.5–2.3 mm) and a thin matrix group (1.0–1.5 mm). The same processes were performed in the nonreverse and reverse matrix insertion groups. Results. Baseline demographics and surgery-related data were summarized according to matrix thickness and direction. There were no significant intergroup differences in the demographic variables such as history of smoking, radiation, or chemotherapy. The mean drain volume was significantly higher in the thick matrix group than that in the thin matrix group ( p = 0.0445 ). However, there were no significant differences in overall complication rates by matrix thickness ( p = 0.3139 ). Additionally, there were no significant differences in complications between the nonreverse and reverse matrix insertion groups ( p = 0.538 ). Conclusion. Our findings suggest that patients with a thick acellular dermal matrix need a prolonged period for engraftment. However, the thickness did not directly affect the surgical outcomes between the thick and thin matrix groups. Likewise, the orientation in which the acellular dermal matrix was inserted did not affect the surgical outcomes including postoperative complications.

scholarly journals Human Acellular Dermal Matrix (Epiflex®) in Immediate Implant-Based Breast Reconstruction after Skin- and Nipple-Sparing Mastectomy and Treatment of Capsular Fibrosis: Results of a Multicenter, Prospective, Observational NOGGO-AWOGyn Study

Breast Care ◽  
2020 ◽  
pp. 1-7
Author(s):  
Lea Beier ◽  
Andree Faridi ◽  
Corina Neumann ◽  
Stefan Paepke ◽  
Christine Mau ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Breast Reconstruction ◽  
Acellular Dermal Matrix ◽  
Complication Rates ◽  
Dermal Matrix ◽  
Capsular Fibrosis ◽  
Multicenter Prospective Cohort Study ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing ◽  
Acellular Dermal

<b><i>Background:</i></b> Over the last decades, the number of acellular dermal matrix (ADM)-assisted implant-based breast reconstructions (IBBR) has substantially increased. However, there is still a lack of prospective data on complication rates. <b><i>Methods:</i></b> We performed a non-interventional, multicenter, prospective cohort study to evaluate complication rates of a human ADM in patients undergoing an IBBR after skin- and nipple-sparing mastectomies. Patients with primary reconstruction (cohort A) and patients undergoing a secondary reconstruction after capsular fibrosis (cohort B) using the human ADM Epiflex® (DIZG gGmbH, Berlin, Germany) were enrolled in this study. Patients were followed-up for 12 months after surgery. <b><i>Results:</i></b> Eighty-four eligible patients were included in this study of whom 28 women underwent a bilateral breast reconstruction, leading to 112 human ADM-assisted reconstructions in total (cohort A: 73, cohort B: 39). In 33.0% of the reconstructed breasts at least one of the complications of primary interest occurred, including implant loss 7.1%, seroma 15.2%; infection 5.4%, rash 8.0%, and Baker grade III/IV capsular fibrosis 2.7%, with no statistically significant differences between the cohorts. Previous radiation therapy was significantly associated with occurrence of any postoperative complication (OR 20.41; <i>p</i> value 0.027). <b><i>Conclusion:</i></b> The rates of most complications were comparable to the rates reported for other ADMs with relatively low rates of capsular fibrosis and infections. The rate of seroma was increased in our study. Prior radiation therapy increased the risk of any postoperative complications. Therefore, the use of ADM in these patients should be considered carefully.

scholarly journals An Initial Experience and Usefulness of Porcine Acellular Dermal Matrix (PADM) Assisted Prepectoral Breast Implant Surgery: Case Series and Systematic Review

2021 ◽  
Author(s):  
Woo Jin Song ◽  
Hyung Bo Sim ◽  
Hyun Gyo Jeong ◽  
Sang Gue Kang
Keyword(s):  
Systematic Review ◽  
Breast Reconstruction ◽  
Breast Implant ◽  
Group Analysis ◽  
Acellular Dermal Matrix ◽  
Complication Rates ◽  
Dermal Matrix ◽  
Implant Surgery ◽  
Porcine Acellular Dermal Matrix ◽  
Acellular Dermal

Abstract Background: We report our experience with performing prepectoral placement breast implant surgery using Supporix TM (HansBiomed, Korea), a porcine acellular dermal matrix (PADM), for cosmetic and reconstructive indications. The clinical efficiency, safety, and cost-effectiveness of PADM were also discussed. Methods: A single-center, retrospective study was designed from December 2017 to December 2019. The participants were Korean female patients who had PADM-assisted prepectoral breast implant surgery performed by two surgeons (S.G.K. & H.B.S.). All complications were registered and analyzed. A systematic review and meta-analysis of the complication rates after PADM-assisted prepectoral breast implant surgery were conducted for comparison with other studies. Subgroup analysis was performed in three groups according to the operation type: the cosmetic breast surgery (CBS) group, the immediate implant-based breast reconstruction (IIBR) group, and the delayed implant-based breast reconstruction (DIBR) group. Results: A total of 20 breasts in 16 patients were included in our study with a median follow-up period of 8.25 months. In a systematic review, 20 publications with a total of 2,504 breasts in 1,921 females were quantitively analyzed. The overall complication rates in our study and other studies were 14% and 24% in total group analysis, 0% and 12% in the CBS group, 62% and 26% in the IIBR group, and 0% and 28% in the DIBR group, respectively.Conclusion: Our data support the effectiveness of PADM-assisted prepectoral breast implant surgery, which was comparable to other studies. PADM was effective for reducing seroma and hematoma in the revision CBS group and the DIBR group. In the IIBR group, it was helpful in preventing implant loss and explantation.

Use of PEAK PlasmaBlade in implant-based breast reconstruction and radiotherapy: new strategy to reduce complications

2021 ◽  
pp. 030089162110560
Author(s):  
Laura Sala ◽  
Stefano Bonomi ◽  
Alessandra Fabbri ◽  
Chiara Maura Ciniselli ◽  
Annalisa Bardelli ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Protective Factor ◽  
Capsular Contracture ◽  
Wound Dehiscence ◽  
Acellular Dermal Matrix ◽  
Complication Rates ◽  
Dermal Matrix ◽  
Plastic Reconstructive Surgery ◽  
Surgeon Satisfaction

Background: Implant-based breast reconstruction in the setting of radiotherapy often leads to higher complications rates (mainly capsular contracture and wound dehiscence) and poor cosmetic outcomes. We hypothesized that the combination of pulsed-electron avalanche knife (PEAK) PlasmaBlade (a pulsed radiofrequency electrosurgery) and acellular dermal matrix Veritas® in postmastectomy radiotherapy implant-based breast reconstruction could result in lower complications rate, better reconstructive results, and patient satisfaction. Methods: A prospective observational study focused on the use of PEAK PlasmaBlade in implant-based breast reconstruction and radiotherapy was carried out in the Plastic Reconstructive Surgery Unit at Fondazione IRCCS Istituto Nazionale Tumori Milano between December 2017 and 2019 (2017–2018: enrollment; 2018–2019: follow-up). Patient demographics were queried and complication rates and patient and surgeon satisfaction were assessed. Results: A total of 88 patients were enrolled; 2 patients received bilateral reconstruction, leading to a total of 90 procedures. Sixty-two women received contralateral symmetrization. Seroma was the most frequent minor complication (8.8%); implant exposure was the most recorded among major complications (5.5%). Preoperative lipofilling was the most substantial protective factor for preventing complications ( p < 0.001). A significant association between capsular thermal damage thickness and the type of electrosurgery used (traditional electrosurgery vs PEAK PlasmaBlade) was observed, with lower values with PEAK PlasmaBlade ( p < 0.0001). Conclusions: Our protocol results in low rates of surgical complications and a high level of patient and surgeon satisfaction although longer follow-up is needed.

The Effect of Acellular Dermal Matrix Use on Complication Rates in Tissue Expander/Implant Breast Reconstruction

2010 ◽  
Vol 64 (5) ◽  
pp. 674-678 ◽  
Author(s):  
Steven T. Lanier ◽  
Eric D. Wang ◽  
John J. Chen ◽  
Balvant P. Arora ◽  
Steven M. Katz ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Tissue Expander ◽  
Acellular Dermal Matrix ◽  
Complication Rates ◽  
Dermal Matrix ◽  
Acellular Dermal ◽  
Implant Breast Reconstruction

scholarly journals The Comparison of Breast Reconstruction Using Two Types of Acellular Dermal Matrix after Breast-Conserving Surgery

2021 ◽  
Vol 10 (15) ◽  
pp. 3430
Author(s):  
Jeongshin An ◽  
Hyungju Kwon ◽  
Woosung Lim ◽  
Byung-In Moon ◽  
Nam Sun Paik
Keyword(s):  
Breast Cancer ◽  
Breast Reconstruction ◽  
Acellular Dermal Matrix ◽  
Breast Conserving Surgery ◽  
The Body ◽  
Surgical Time ◽  
Dermal Matrix ◽  
Specimen Weight ◽  
Breast Shape ◽  
Acellular Dermal

Breast reconstruction during breast-conserving surgery (BCS) can improve the breast shape. This study introduces breast reconstruction in BCS with two types of acellular dermal matrix (ADM). The study included 134 patients who underwent BCS due to breast cancer from February 2018 to May 2021. This study was conducted by one surgeon, and is the result of a three-year study. The patient group who underwent BCS using ADM was mainly targeted at patients with minor to severe defects after the operation. The average age of the patients was 51.8 years, and the body mass index (BMI) was 23.8 kg/m. The specimen weight was 30–120 g. The average surgical time, including reconstruction, was 100.4 min, combined with reconstruction. There were minor complications in six patients. The advantage of using ADM is that it can quickly correct the shape of the breast after conventional BCS surgery. Pellet-type ADM, rather than sheet-type, can create a breast shape similar to that before surgery. Breast reconstruction using ADM can be an easy and convenient method for making a better shape from BCS.

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