A comparative study of pre- or subpectoral expander position with the fenestrated Acellular dermal matrix anterior coverage, on drainage volume and Seroma Formation after Non-Nipple-Sparing Mastectomy

Suh, Young Chul; Kim, Jin Kwan; Kim, Na Rim; Choi, Jung Sik; Kim, Young Jin; Lee, Jung Ho; Jun, Young Joon

doi:10.1016/j.bjps.2021.01.015

Cited by 11 publications

(14 citation statements)

References 28 publications

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“…We did observe an increased rate of seroma with prepectoral technique. However, evidence in literature including a large meta-analysis by Abbate et al, does not seem to corroborate this finding 19,20,26–29 . Aforementioned studies comprise a mixture of patients who underwent direct-to-implant reconstructions in addition to expanders, which might account for the different outcome.…”

Section: Discussionmentioning

confidence: 98%

“…However, evidence in literature including a large meta-analysis by Abbate et al, does not seem to corroborate this finding. 19,20,[26][27][28][29] Aforementioned studies comprise a mixture of patients who underwent direct-to-implant reconstructions in addition to expanders, which might account for the different outcome. The mastectomy skin flap status is likely more favorable in direct-to-implant reconstructions, expediting incorporation of ADM to skin.…”

Section: Discussionmentioning

confidence: 99%

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Seroma After Breast Reconstruction With Tissue Expanders

Öztürk

Magner

et al. 2023

Ann Plast Surg

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BackgroundSeroma is a relatively common complication after breast reconstruction with tissue expanders. The main risk in the presence of seroma is development of periprosthetic infection, which can lead to implant loss. Our goals were to identify risk factors for seroma, and to describe our protocol for managing fluid accumulation.Patients and MethodsAn IRB approved breast reconstruction database was reviewed to identify patients who underwent tissue expander reconstruction. Patient characteristics, details of surgery, outcomes and treatment were recorded.ResultsTwo hundred nineteen tissue expander reconstructions were performed in 138 patients. Twenty-eight reconstructions developed seroma (12.8%), and 75 were identified to have prolonged drains (34.2%). Seroma was more common in patients with lymph node surgery (P = 0.043), delayed reconstruction (P = 0.049), and prepectoral reconstruction (P = 0.002). Seroma and/or prolonged drains were more commonly noted in patients with higher body mass index (P = 0.044) and larger breast size (P = 0.001). Aspiration was the most common intervention (85.7%), which was performed in the clinic utilizing the expander port site. There was no difference in infection or explantation rate between seroma and no-seroma patients (P = 0.546 and 0.167), whereas patients with any fluid concern (seroma and/or prolonged drains) were more prone to developing infection and undergoing explantation (P = 0.041 and P < 0.005).ConclusionWe recommend that prolonged drain placement longer than 3 weeks should be avoided, and patients should be screened for fluid accumulation after drain removal. Serial aspiration via expander port site and continuation of expansion provide a safe and effective method to manage seromas to avoid infection and expander loss.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Seroma After Breast Reconstruction With Tissue Expanders

Öztürk

Magner

et al. 2023

Ann Plast Surg

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“…In a study looking at drain times for tissue expander patients, Suh et al found that there was no difference in time to drain removal between pre-pectoral and subpectoral expander patients. 10 In another study looking at tissue expander patients, Schaeffer et al found that the time to drain removal in prepectoral patients was less than the time to drain removal in dual plane patients. 18 Compared with the studies by Suh et al and Schaeffer et al, our study had a smaller sample size of prepectoral tissue expander patients.…”

Section: Prs Global Open • 2022mentioning

confidence: 99%

“…Suh et al found that there were no significant differences in rates of hematoma, seroma, explantation, infection, or flap necrosis between the dual plane and pre-pectoral techniques. 10 In another study composed of patients receiving implants, pre-pectoral implant placement had fewer revision surgeries and no significant difference in complication rates of hematoma, seroma, infection, implant loss, or full thickness necrosis compared with the dual plane group. 1 In a metanalysis by Li et al that compared the two surgical approaches for both implant and tissue expander reconstructions, there were no significant differences in complication rates of implant loss, nipple or skin flap necrosis, seroma, infection, hematoma, re-operation, wound dehiscence, or overall complications.…”

Section: Introductionmentioning

confidence: 96%

Drain Removal Time in Pre-pectoral versus Dual Plane Prosthetic Breast Reconstruction following Nipple-sparing Mastectomy

Moriarty

Baker

Hart

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: Pre-pectoral prosthetic breast reconstruction following nipple-sparing mastectomy (NSM) has become a popular approach compared with the dual plane technique. Our objective was to determine if there was a difference in time to postoperative breast drain removal in direct-to-implant or tissue expander reconstruction following NSM when comparing pre-pectoral with dual plane technique. Methods: A total of 200 patients (335 breasts) received NSM followed by implant or expander reconstruction at our institution between the years 2009 and 2020. Direct-to-implant reconstruction had 113 pre-pectoral versus 67 dual plane, and tissue expander reconstruction had six pre-pectoral versus 149 dual plane. Our analysis included age at mastectomy, body mass index, history of preoperative breast radiation, and smoking history. Case complications included seroma or hematoma, breast or axillary infection requiring antibiotics or operative washout, device replacement due to extrusion or infection, skin necrosis, and capsular contracture. Statistical analysis was completed with Pearson chi-square test, Fisher exact test, and the two-sample T-test using IBM SPSS Statistics 24.0 (IBM Corp., Armonk, N.Y.). Results:The average time until breast drain removal in dual plane implant patients was significantly less than in pre-pectoral implant patients (9.42 versus 14.01 days). The average time until breast drain removal in dual plane expander patients was significantly less than in pre-pectoral expander patients (11.47 versus 20.30 days). Conclusion:In both implant and expander reconstruction following NSM, patients receiving dual plane device placement had a shorter postoperative time until breast drain removal when compared with patients receiving pre-pectoral device placement.

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“…A study reported the acceptable rates of reoperations and implant loss of ADM after investigating the complications, reconstructive failure, and possible risk factors in direct-to-implant breast reconstruction with ADM (primarily Strattice ™ ) [97]. Moreover, breast reconstruction using ADM for the complete coverage of implants has been shown to reduce such complications and improve the aesthetic outcomes [99]. In addition, ADMs have also been used as a common filler in a variety of areas such as nose, vaginal, penile girth, and urethral plastic surgery.…”

Section: Applications In Plastic Surgerymentioning

confidence: 99%

Advances on the modification and biomedical applications of acellular dermal matrices

et al. 2022

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Acellular dermal matrix (ADM) is derived from natural skin by removing the entire epidermis and the cell components of dermis, but retaining the collagen components of dermis. It can be used as a therapeutic alternative to “gold standard” tissue grafts and has been widely used in many surgical fields, since it possesses affluent predominant physicochemical and biological characteristics that have attracted the attention of researchers. Herein, the basic science of biologics with a focus on ADMs is comprehensively described, the modification principles and technologies of ADM are discussed, and the characteristics of ADMs and the evidence behind their use for a variety of reconstructive and prosthetic purposes are reviewed. In addition, the advances in biomedical applications of ADMs and the common indications for use in reconstructing and repairing wounds, maintaining homeostasis in the filling of a tissue defect, guiding tissue regeneration, and delivering cells via grafts in surgical applications are thoroughly analyzed. This review expectedly promotes and inspires the emergence of natural raw collagen-based materials as an advanced substitute biomaterial to autologous tissue transplantation. Graphical Abstract

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A comparative study of pre- or subpectoral expander position with the fenestrated Acellular dermal matrix anterior coverage, on drainage volume and Seroma Formation after Non-Nipple-Sparing Mastectomy

Cited by 11 publications

References 28 publications

Seroma After Breast Reconstruction With Tissue Expanders

Seroma After Breast Reconstruction With Tissue Expanders

Drain Removal Time in Pre-pectoral versus Dual Plane Prosthetic Breast Reconstruction following Nipple-sparing Mastectomy

Advances on the modification and biomedical applications of acellular dermal matrices

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