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CC BY-NC-ND 4.0 · Arch Plast Surg 2022; 49(02): 166-173
DOI: 10.1055/s-0042-1744408
Breast/Trunk
Case Report

Meshed Acellular Dermal Matrix for Two-Staged Prepectoral Breast Reconstruction: An Institutional Experience

Jessica Luo‡   *
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
,
Rhett N. Willis Jr‡   *
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
,
Suzanna M. Ohlsen
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
,
Meghan Piccinin
2   Michigan State University College of Osteopathic Medicine, East Lansing, Michigan
,
Neal Moores
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
,
Alvin C. Kwok
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
,
Jayant P. Agarwal
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
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Abstract

The introduction of acellular dermal matrix (ADM) to breast reconstruction has allowed surgeons to reexplore the prepectoral implant placement technique in postmastectomy breast reconstruction. Our institution adopted a novel approach using meshed ADM to lessen the financial burden of increased ADM utilization with the prepectoral breast reconstruction. This is a retrospective, single-center review of two-stage prepectoral breast reconstruction using meshed human-derived ADM for anterior prosthesis coverage. Patient demographics, oncologic data, perioperative characteristics, and complications were examined and reported as means with standard deviations. Cost-saving with the meshed technique was evaluated. Forty-eight patients (72 breasts) with a mean age of 48.5 ± 15.0 years (range 26–70 years) were included in the study. The mean follow-up time was 13.2 ± 4.4 months (range 4.1–25.8 months). Nineteen breasts (24.6%) experienced complications, with seromas being the most common complication (12.5%, n = 9). Expander removal and reoperation occurred at a rate of 8.3 and 9.7%, respectively. The average time to drain removal was 18.8 ± 6.6 days (range 8–32 days). Meshed ADM provided an average cost savings of $6,601 for unilateral and $13,202 for bilateral reconstructions. Our study found that human-derived meshed ADM can be safely used in two-staged prepectoral tissue expander-based breast reconstruction and can result in significant cost savings.

Keywords

acellular dermal matrix - prepectoral - breast reconstruction - meshed - case reports

Author Contributions

Conceptualization: R.N.W.-Jr, N.M., A.C.K., J.P.A. Data curation: J.L., R.N.W.-Jr, S.M.O., M.P. Investigation: J.L., R.N.W.-Jr, A.C.K., J.P.A. Methodology: J.L., R.N.W.-Jr, A.C.K., J.P.A. Project administration: J.L., R.N.W.-Jr, A.C.K., J.P.A. Supervision, validation, visualization: A.C.K., J.P.A. Writing - original draft: J.L., R.N.W.-Jr, S.M.O. Writing - review and editing: J.L., A.C.K., J.P.A.


Ethical Approval

This study was exempted by the Institutional Review Board of University of Utah Hospital (IRB00081784) and performed in accordance with the principles of the Declaration of Helsinki. The informed consent was waived because this study design is a retrospective chart review.


Patient Consent

The patients provided written informed consent for the publication and the use of their images.


Prior Presentation

This article was presented at the Mountain West Society of Plastic Surgeons, Squaw Valley, Lake Tahoe, March 7–10, 2019.


* The two authors contributed equally to this work.




Publication History

Article published online:
06 April 2022

© 2022. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Bloom JA, Patel K, Cohen S. et al. Prepectoral breast reconstruction: an overview of the history, technique, and reported complications. Open Access Surg 2020; 13: 1-9
    CrossrefGoogle Scholar
  • 2 Zenn MR. Indications and controversies for implant-based breast reconstruction utilizing biological meshes. Clin Plast Surg 2018; 45 (01) 55-63
    CrossrefPubMedGoogle Scholar
  • 3 Sigalove S. Options in acellular dermal matrix-device assembly. Plast Reconstr Surg 2017; 140 (6S Prepectoral Breast Reconstruction): 39S-42S
    CrossrefPubMedGoogle Scholar
  • 4 Hagarty SE, Yen LL, Luo J, Fosco CR, Gomez K, Khare M. Decreased length of postoperative drain use, parenteral opioids, length of stay, and complication rates in patients receiving meshed versus unmeshed acellular dermal matrix in 194 submuscular tissue expander-based breast reconstructions: a single-surgeon cohort study. Plast Reconstr Surg 2020; 145 (04) 889-897
    CrossrefPubMedGoogle Scholar
  • 5 Uzunismail A, Duman A, Perk C. et al. The effects of acellular dermal allograft (AlloDerm®) interface on silicone-related capsule formation—experimental study. Eur J Plast Surg 2008; 31: 179-185
    CrossrefGoogle Scholar
  • 6 Salzberg CA, Ashikari AY, Berry C, Hunsicker LM. Acellular dermal matrix-assisted direct-to-implant breast reconstruction and capsular contracture: a 13-year experience. Plast Reconstr Surg 2016; 138 (02) 329-337
    CrossrefPubMedGoogle Scholar
  • 7 Sigalove S, Maxwell GP, Sigalove NM. et al. Prepectoral implant-based breast reconstruction: rationale, indications, and preliminary results. Plast Reconstr Surg 2017; 139 (02) 287-294
    CrossrefPubMedGoogle Scholar
  • 8 Zammit D, Kanevsky J, Meng FY. et al. Meshed acellular dermal matrix: technique and application in implant based breast reconstruction. Plast Aesthet Res 2016; 3: 254-256
    CrossrefGoogle Scholar
  • 9 Ibrahim AM, Koolen PG, Ashraf AA. et al. Acellular dermal matrix in reconstructive breast surgery: survey of current practice among plastic surgeons. Plast Reconstr Surg Glob Open 2015; 3 (04) e381
    CrossrefPubMedGoogle Scholar
  • 10 Kim SE. Prepectoral breast reconstruction. Yeungnam Univ J Med 2019; 36 (03) 201-207
    CrossrefPubMedGoogle Scholar
  • 11 Lotan AM, Ben Yehuda D, Allweis TM, Scheflan M. Comparative study of meshed and nonmeshed acellular dermal matrix in immediate breast reconstruction. Plast Reconstr Surg 2019; 144 (05) 1045-1053
    CrossrefPubMedGoogle Scholar
  • 12 Paprottka FJ, Krezdorn N, Sorg H. et al. Evaluation of complication rates after breast surgery using acellular dermal matrix: median follow-up of three years. Plast Surg Int 2017; 2017: 1283735
    PubMedGoogle Scholar
  • 13 Gravina PR, Pettit RW, Davis MJ, Winocour SJ, Selber JC. Evidence for the use of acellular dermal matrix in implant-based breast reconstruction. Semin Plast Surg 2019; 33 (04) 229-235
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Hallberg H, Rafnsdottir S, Selvaggi G. et al. Benefits and risks with acellular dermal matrix (ADM) and mesh support in immediate breast reconstruction: a systematic review and meta-analysis. J Plast Surg Hand Surg 2018; 52 (03) 130-147
    CrossrefPubMedGoogle Scholar
  • 15 Nealon KP, Weitzman RE, Sobti N. et al. Prepectoral direct-to-implant breast reconstruction: safety outcome endpoints and delineation of risk factors. Plast Reconstr Surg 2020; 145 (05) 898e-908e
    CrossrefPubMedGoogle Scholar
  • 16 Baker BG, Irri R, MacCallum V, Chattopadhyay R, Murphy J, Harvey JR. A prospective comparison of short-term outcomes of subpectoral and prepectoral Strattice-based immediate breast reconstruction. Plast Reconstr Surg 2018; 141 (05) 1077-1084
    CrossrefPubMedGoogle Scholar
  • 17 Wormer BA, Valmadrid AC, Ganesh Kumar N. et al. Reducing expansion visits in immediate implant-based breast reconstruction: a comparative study of prepectoral and subpectoral expander placement. Plast Reconstr Surg 2019; 144 (02) 276-286
    CrossrefPubMedGoogle Scholar
  • 18 Jafferbhoy S, Chandarana M, Houlihan M. et al. Early multicentre experience of pre-pectoral implant based immediate breast reconstruction using Braxon® . Gland Surg 2017; 6 (06) 682-688
    CrossrefPubMedGoogle Scholar
  • 19 Lee JS, Kim JS, Lee JH. et al. Prepectoral breast reconstruction with complete implant coverage using double-crossed acellular dermal matrixs. Gland Surg 2019; 8 (06) 748-757
    CrossrefPubMedGoogle Scholar
  • 20 Heidemann LN, Gunnarsson GL, Salzberg CA, Sørensen JA, Thomsen JB. Complications following nipple-sparing mastectomy and immediate acellular dermal matrix implant-based breast reconstruction: a systematic review and meta-analysis. Plast Reconstr Surg Glob Open 2018; 6 (01) e1625
    CrossrefPubMedGoogle Scholar
  • 21 Martin JB, Moore R, Paydar KZ, Wirth GA. Use of fenestrations in acellular dermal allograft in two-stage tissue expander/implant breast reconstruction. Plast Reconstr Surg 2014; 134 (05) 901-904
    CrossrefPubMedGoogle Scholar
  • 22 Palaia DA, Arthur KS, Cahan AC, Rosenberg MH. Incidence of seromas and infections using fenestrated versus nonfenestrated acellular dermal matrix in breast reconstructions. Plast Reconstr Surg Glob Open 2015; 3 (11) e569
    CrossrefPubMedGoogle Scholar
  • 23 Wirth GA, Mowlds DS, Guidotti P. et al. Acellular dermal matrix fenestrations and their effect on breast shape. Eur J Plast Surg 2015; 38: 267-272
    CrossrefGoogle Scholar
  • 24 Cottler PS, Olenczak JB, Ning B. et al. Fenestration improves acellular dermal matrix biointegration: an investigation of revascularization with photoacoustic microscopy. Plast Reconstr Surg 2019; 143 (04) 971-981
    CrossrefPubMedGoogle Scholar
  • 25 Hoppe IC, Yueh JH, Wei CH, Ahuja NK, Patel PP, Datiashvili RO. Complications following expander/implant breast reconstruction utilizing acellular dermal matrix: a systematic review and meta-analysis. Eplasty 2011; 11: e40
    PubMedGoogle Scholar
  • 26 Lee KT, Mun GH. Updated evidence of acellular dermal matrix use for implant-based breast reconstruction: a meta-analysis. Ann Surg Oncol 2016; 23 (02) 600-610
    CrossrefPubMedGoogle Scholar
  • 27 Kim JYS, Mlodinow AS. What's new in acellular dermal matrix and soft-tissue support for prosthetic breast reconstruction. Plast Reconstr Surg 2017; 140 (5S Advances in Breast Reconstruction): 30S-43S
    CrossrefPubMedGoogle Scholar
  • 28 Bank J, Phillips NA, Park JE, Song DH. Economic analysis and review of the literature on implant-based breast reconstruction with and without the use of the acellular dermal matrix. Aesthetic Plast Surg 2013; 37 (06) 1194-1201
    CrossrefPubMedGoogle Scholar
  • 29 Nahabedian MY. Acellular dermal matrices in primary breast reconstruction: principles, concepts, and indications. Plast Reconstr Surg 2012; 130 (5, Suppl 2): 44S-53S
    CrossrefPubMedGoogle Scholar
  • 30 Nahabedian MY. Prosthetic breast reconstruction with acellular dermal matrices: achieving predictability and reproducibility. Plast Reconstr Surg Glob Open 2016; 4 (05) e698
    CrossrefPubMedGoogle Scholar