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Background: Implant covering with an interface material is the standard in prepectoral breast reconstruction. Acellular dermal matrix (ADM) is frequently used, but it is expensive and associated with complications. Alternatively, we have been using integrated devices consisting of a silicone implant coated with polyurethane (PU) foam. We aimed to compare both techniques in terms of acute complications. Methods: The authors retrospectively reviewed patients undergoing prepectoral direct-to-implant reconstruction from June 2018 to January 2022. Two cohorts were defined based on the interface material used: ADM versus PU. Total drainage volume, time to drain removal, and acute complications (hematoma, seroma, infection, and explantation) were analyzed. Results: Forty-four breast reconstructions were performed in 35 patients (10 bilateral); implants were covered with ADM in 23 cases and with PU foam in 21. Median total drainage volume (500 versus 515 cc for ADM and PU, respectively) and time to drain removal (9 versus 8 days) were not affected by the interface material used, but seromas and infections occurred exclusively in the ADM cohort (seromas in four of 23 of cases, P = 0.109; infections in three of 23 cases, P = 0.234). Overall complications occurred more often in cases reconstructed with ADM, but the difference was nonsignificant ( P = 0.245). Conclusions: The use of interface materials is generally considered a prerequisite for state-of-the-art prepectoral breast reconstruction for a variety of reasons, including the prevention of capsular contracture. In this study, PU coating tended to be associated with fewer short-term complications than ADM, including seroma and infection.

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Background Various classifications of mandibular defects have been attempted, but no universally accepted system exists. After 25 years of experience, the senior author idealized a new mandibulectomy classification which could give a more detailed anatomical description leading to a more precise algorithm for reconstruction. Methods A new classification of mandibular defects is proposed: class I (anterior arch), class II (body), class III (ascending ramus), class IV (hemimandibulectomy), and class V (extended mandibulectomy). Each class is further subdivided into those that preserve or resect intra- and/or extraoral soft tissues (ABCD). This classification takes in account four factors that need to be thought when planning mandibular reconstruction: location/specificity of the defect, osteotomies, and bone and soft tissue requirements. Results A total of 218 defects were classified according to this new classification. Nearly 40% of the cases were classified as a class I defect followed by class IV (36,7%), class II (16%), class V (6,8%), and class III (0,5%). The authors also created an algorithm for reconstruction. In cases of an “only-bone” defect, the free iliac crest flap is the preferable choice, especially in class I and IV. When intra- or extraoral soft tissue is needed (types B and C), the fibula flap is our choice of excellence. In cases of extensive defects (type D), the fibula flap and the sequentially linked flow through flap are the preferred options. Conclusions Optimizing mandibular defect classification with better integration of data-driven information along with clinicopathological evidences and related experience allows for better clinical judgment and choices. We believe that our new classification system and algorithm for reconstruction can be a valuable guiding tool for dealing with complex mandibular reconstruction. Level of evidence: Level III, therapeutic study

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