“A Comparative Study of Wrap-Around versus Anterior Coverage Placement of Acellular Dermal Matrix in Prepectoral Breast Reconstruction”

Abstract

Background: Prepectoral direct-to-implant insertion (DTI) with acellular dermal matrix (ADM) is the currently preferred operation for breast reconstruction. There are different placements of ADM, which are largely classified as wraparound placement or anterior coverage placement. Because there are limited data comparing these two placements, this study aimed to compare the outcomes of these two methods. Methods: This was a retrospective study of immediate prepectoral DTI breast reconstructions performed by a single surgeon between 2018 and 2020. Patients were classified depending on the ADM placement type used. Surgical outcomes and breast shape changes using nipple position during follow-up were compared. Results: A total of 159 patients were included in the study, with 87 in the wraparound group and 72 in the anterior coverage group. Demographics were similar between the two groups, excluding ADM amount used (154.1 cm 2 versus 137.8 cm 2 ; P = 0.01). There were no significant differences in the overall rate of complications between the two groups, including seroma (6.90% versus 5.56%; P = 1.0), total drainage amount (762.1 mL versus 805.9 mL; P = 0.45), and capsular contracture (4.6% versus 1.39%; P = 0.38). The wraparound group had a significantly longer distance change than that of the anterior coverage group in the sternal notch-to-nipple distance (4.44% versus 2.08%; P = 0.03) and midclavicle-to-nipple distance (4.94% versus 2.64%; P = 0.04). Conclusions: Wraparound and anterior coverage placement of ADM in prepectoral DTI breast reconstruction showed similar complication rates, including seroma, drainage amount, and capsular contracture. However, wraparound placement can make the breast more ptotic in shape compared with anterior coverage placement.

Discussion: A Comparative Study of Wraparound versus Anterior Coverage Placement of Acellular Dermal Matrix in Prepectoral Breast Reconstruction

“…T he study "A Comparative Study of Wraparound versus Anterior Coverage Placement of Acellular Dermal Matrix in Prepectoral Breast Reconstruction," by Han et al, is a retrospective review of 159 matched patients undergoing skinsparing or nipple-sparing mastectomies; approximately half underwent reconstruction with a complete encapsulation by acellular dermal matrix (ADM) and the other half with only anterior coverage by ADM. 1 The authors found no statistical difference in seroma formation, capsular contracture rate, or total drainage. The only significant finding was a greater degree of postoperative ptosis (midclavicle-and sternal notch-to-nipple distances) in the group that had total ADM wrap (4.94%) compared with the anterior only ADM coverage (2.64%).…”

Navigating the Pandemic: Shifts in Breast Reconstruction Trends and Surgical Decision-Making in the United States

“…DTI techniques, particularly prepectoral implant placement with the use of acellular dermal matrices (ADMs), have gained popularity in recent years [11]. Prepectoral implant placement involves positioning the implant above the pectoralis major muscle, as opposed to the traditional subpectoral placement.…”

Anterior Tenting vs. Wrapping Technique for Acellular Dermal Matrix in Breast Reconstruction under Post-mastectomy Radiotherapy in Rats

“…In clinical practice, a study has reported no signi cant difference in complications between the anterior-tenting and whole-wrapping techniques. 13 However, another study has suggested that using a larger ADM, rather than a thicker one, may increase the drainage volume and duration, which could potentially increase the risk of seroma or infection. 14 However, the speci c differences between these techniques remain unclear, and the selection of the coverage method often relies on surgeons' preferences.…”