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Comparison of Outcomes in Immediate Implant-Based Breast Reconstruction: Acellular Dermal Matrix versus Inferior Dermal Flap

  • Ribeiro, Luis Mata (Plastic and Reconstructive Surgery Department, Centro Hospitalar Universitario Lisboa Central, Hospital Sao Jose) ;
  • Meireles, Rita P. (Plastic and Reconstructive Surgery Department, Centro Hospitalar e Universitario de Coimbra) ;
  • Brito, Iris M. (Plastic and Reconstructive Surgery Department, Centro Hospitalar e Universitario de Coimbra) ;
  • Costa, Patricia M. (Plastic and Reconstructive Surgery Department, Centro Hospitalar Universitario Lisboa Central, Hospital Sao Jose) ;
  • Rebelo, Marco A. (Plastic and Reconstructive Surgery Department, Instituto Portugues de Oncologia do Porto) ;
  • Barbosa, Rui F. (Plastic and Reconstructive Surgery Department, Instituto Portugues de Oncologia do Porto) ;
  • Choupina, Miguel P. (Plastic and Reconstructive Surgery Department, Instituto Portugues de Oncologia do Porto) ;
  • Pinho, Carlos J. (Plastic and Reconstructive Surgery Department, Instituto Portugues de Oncologia do Porto) ;
  • Ribeiro, Matilde P. (Plastic and Reconstructive Surgery Department, Instituto Portugues de Oncologia do Porto)
  • Published : 2022.03.15

Abstract

Background Implant-based breast reconstruction has evolved tremendously in the last decades, mainly due to the development of new products and techniques that make the procedure safer and more reliable. The purpose of this study was to compare the outcomes in immediate one-stage breast reconstruction between acellular dermal matrix (ADM) and inferior dermal flap (IDF). Methods We conducted a retrospective comparative study of patients submitted to immediate breast reconstructions with an anatomical implant and ADM or IDF in a single center between 2016 and 2018. Outcomes evaluated included major complications, early complications, reinterventions, readmissions, and reconstruction failure. Simple descriptive statistics and univariate analysis were performed. Results A total of 118 breast reconstructions (85 patients) were included in the analysis. Patients in the IDF group had a higher body mass index (median = 27.0) than patients in the ADM group (median = 24). There were no statistically significant differences among both groups regarding immediate major complication, early complications, readmissions, and reinterventions. Conclusion There are no significant differences in complications between the ADM and IDF approach to immediate implant breast reconstruction. In patients with higher body mass index and large, ptotic breasts, we recommend an immediate implant reconstruction with IDF.

Keywords

Acknowledgement

We would like to thank Edgar Mesquita for helping with the statistical analyses included in the article.

References

  1. Nair A, Jaleel S, Abbott N, Buxton P, Matey P. Skin-reducing mastectomy with immediate implant reconstruction as an indispensable tool in the provision of oncoplastic breast services. Ann Surg Oncol 2010;17(09):2480-2485 https://doi.org/10.1245/s10434-010-1058-4
  2. Ellabban MA, Nawar A, Milad H, Ellabban MG. Single-stage immediate breast reconstruction using anatomical silicone-based implant and the hammock technique of dermal-muscle flap in large and ptotic breasts: a multicenter study. World J Surg 2020;44(06):1925-1931 https://doi.org/10.1007/s00268-020-05416-2
  3. Tasoulis MK, Teoh V, Khan A, Montgomery C, Mohammed K, Gui G. Acellular dermal matrices as an adjunct to implant breast reconstruction: analysis of outcomes and complications. Eur J Surg Oncol 2020;46(4 Pt A):511-515 https://doi.org/10.1016/j.ejso.2019.10.042
  4. Krishnan NM, Fischer JP, Basta MN, Nahabedian MY. Is single-stage prosthetic reconstruction cost effective? A cost-utility analysis for the use of direct-to-implant breast reconstruction relative to expander-implant reconstruction in postmastectomy patients. Plast Reconstr Surg 2016;138(03):537-547 https://doi.org/10.1097/PRS.0000000000002428
  5. Remington AC, Gurtner GC, Wan DC, Nguyen D, Momeni A. Identifying risk factors for postoperative major complications in staged implant-based breast reconstruction with AlloDerm. Breast J 2019;25(04):597-603 https://doi.org/10.1111/tbj.13299
  6. Greig H, Roller J, Ziaziaris W, Van Laeken N. A retrospective review of breast reconstruction outcomes comparing AlloDerm and DermaCELL. JPRAS Open 2019;22:19-26 https://doi.org/10.1016/j.jpra.2019.07.005
  7. Israeli Ben-Noon H, Farber N, Weissman O, et al.Israeli Ben-noon HThe effect of acellular dermal matrix on drain secretions after immediate prosthetic breast reconstruction. J Plast Surg Hand Surg 2013;47(04):308-312 https://doi.org/10.3109/2000656X.2013.766202
  8. Hon HH, Mubang RN, Wernick BD, et al. Acellular dermal matrix versus inferior deepithelialized flap breast reconstruction: equivalent outcomes, with increased cost. Plast Reconstr Surg Glob Open 2017;5(06):e1382
  9. Bostwick J. Prophylactic (risk-reducing) mastectomy and reconstruction. In: Bostwick J, ed. Plastic and Reconstructive Breast Surgery. Vol. II. St. Louis, MO: Quality Medical Publishing; 1990:1369-1373
  10. Hammond DC, Capraro PA, Ozolins EB, Arnold JF. Use of a skin-sparing reduction pattern to create a combination skin-muscle flap pocket in immediate breast reconstruction. Plast Reconstr Surg 2002;110(01):206-211 https://doi.org/10.1097/00006534-200207000-00035
  11. Jepsen C, Hallberg H, Pivodic A, Elander A, Hansson E. Complications, patient-reported outcomes, and aesthetic results in immediate breast reconstruction with a dermal sling: a systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2019;72(03):369-380 https://doi.org/10.1016/j.bjps.2018.12.046
  12. Hansson E, Jepsen C, Hallberg H. Breast reconstruction with a dermal sling: a systematic review of surgical modifications. J Plast Surg Hand Surg 2019;53(01):1-13 https://doi.org/10.1080/2000656x.2018.1533840
  13. Dietz J, Lundgren P, Veeramani A, et al. Autologous inferior dermal sling (autoderm) with concomitant skin-envelope reduction mastectomy: an excellent surgical choice for women with macromastia and clinically significant ptosis. Ann Surg Oncol 2012;19(10):3282-3288 https://doi.org/10.1245/s10434-012-2549-2
  14. Lee KT, Hong SH, Jeon BJ, Pyon JK, Mun GH, Bang SI. Predictors for prolonged drainage following tissue expander-based breast reconstruction. Plast Reconstr Surg 2019;144(01):9e-17e https://doi.org/10.1097/PRS.0000000000005697
  15. Chandarana MN, Jafferbhoy S, Marla S, Soumian S, Narayanan S. Acellular dermal matrix in implant-based immediate breast reconstructions: a comparison of prepectoral and subpectoral approach. Gland Surg 2018;7(Suppl 1):S64-S69 https://doi.org/10.21037/gs.2018.03.05
  16. King ICC, Harvey JR, Bhaskar P. One-stage breast reconstruction using the inferior dermal flap, implant, and free nipple graft. Aesthetic Plast Surg 2014;38(02):358-364 https://doi.org/10.1007/s00266-014-0276-8
  17. Ladizinsky DA, Sandholm PH, Jewett ST, Shahzad F, Andrews K. Breast reconstruction with the Bostwick autoderm technique. Plast Reconstr Surg 2013;132(02):261-270 https://doi.org/10.1097/PRS.0b013e3182958774
  18. Patrinely JR, Farinas A, Al-Majed B, Forte AJ, TerKonda S, Perdikis G. Acellular dermal matrix performance compared with latissimus dorsi myocutaneous flap in expander-based breast reconstruction. Plast Reconstr Surg Glob Open 2019;7(09):e2414 https://doi.org/10.1097/GOX.0000000000002414