Acellular Dermal Matrix for Reoperative Breast Augmentation

Maxwell, G. Patrick; Gabriel, Allen

doi:10.1097/prs.0000000000000777

Cited by 58 publications

(27 citation statements)

References 38 publications

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“…The advent of biologic meshes brought acellular dermal matrices into play, which attempt to restore soft tissue structural support to the breast. 6 , 7 More recently, creative approaches to correct malposition have been described, including the use of the shoelace breast cast and neo-pocket creation. 8 – 10 Although all these techniques have been described, few studies have examined risk factors for implant malposition in the reconstructive population.…”

Section: Introductionmentioning

confidence: 99%

Lateral and Inferior Implant Malposition in Prosthetic Breast Reconstruction: Incidence and Risk Factors

Fracol

Qiu

Chiu

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Background: Implant malposition is one of the most common causes for revision after prosthetic breast reconstruction. There is a paucity of research on the incidence, etiology and risk factors for implant malposition in this setting. Methods: Retrospective review of a single surgeon’s prosthetic breast reconstructions was performed. Variables collected included age, BMI, radiation, chemotherapy, implant characteristics and malposition location (inferior or lateral). Binary logistic regression identified risk factors for malposition. Chi-square test assessed malposition rate as a function of implant volume to BMI subgroups. Results: Of 836 breasts, 82 (9.8%) exhibited implant malposition. Risk factors for any malposition were older age (OR 1.05, 95% CI 1.02-1.07), BMI<25 (OR 1.64, 95% CI 1.00-2.70) and bilateral reconstruction (OR 13.41, 95% CI 8.50-21.16). Risk factors for inferior malposition were older age (OR 1.04, 95% CI 1.01-1.06), BMI<25 (OR 3.43, 95% CI 1.88-6.26) and bilateral reconstructions (OR 11.50, 95% CI 6.79-19.49), while risk factors for lateral malposition were only older age (OR 1.05, 95% CI 1.02-1.08) and bilateral reconstructions (OR 7.08, 95% CI 4.09-12.26). Post-mastectomy radiation was protective against lateral malposition (OR 0.30, 95% CI 0.10-0.88). Stratification by implant volume and BMI demonstrated patient subgroups with distinct patterns of malposition (incidence 0.0% versus 10.9%, P = 0.001). Conclusions: This is the first study to identify risk factors for implant malposition after prosthetic breast reconstruction. Different risk factors contributed to malposition in different directions. The effect of implant size on malposition was mediated through BMI, highlighting the interplay of implant and patient characteristics with respect to malposition.

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Section: Introductionmentioning

confidence: 99%

Lateral and Inferior Implant Malposition in Prosthetic Breast Reconstruction: Incidence and Risk Factors

Fracol

Qiu

Chiu

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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“…Following the introduction of acellular dermal matrices (ADM), their use in breast reconstruction has increased dramatically and is estimated to be upwards of 60%‐75% in staged implant‐based breast reconstruction . The proposed benefits for using ADM in staged implant‐based breast reconstruction include improved lower pole projection, support of the overlying mastectomy skin, control of the implant pocket, increased rate of expansion, decreased long‐term rate of capsular contracture, and decreased rippling . However, ADM usage is not without complications.…”

Section: Introductionmentioning

confidence: 99%

Identifying risk factors for postoperative major complications in staged implant‐based breast reconstruction with AlloDerm

et al. 2019

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Acellular dermal matrices (ADM) have reportedly been associated with postoperative complications following breast reconstruction. The purpose of this study was to identify risk factors predictive of major postoperative complications after staged implant‐based breast reconstruction with ADM. A retrospective study of all patients who underwent implant‐based breast reconstruction with AlloDerm between 2013 and 2017 was conducted. Demographic information, procedural data, and postoperative complications were retrieved. The main objective was to analyze patient and procedural factors associated with the occurrence of major complications, including postoperative readmission and loss of reconstruction. A total of 166 patients (288 breasts) were included. Major complications were noted in 19.9%. The overall rate of infection and mastectomy skin necrosis was 16.9% and 6.6%, respectively. Readmission occurred in 16.3% and loss of reconstruction occurred in 8.4% of patients. Risk factors for major complications included body mass index (BMI) >27.0 kg/m2 (OR 2.46; p = 0.041), higher tissue expander volume (p = 0.049), history of chemotherapy (OR 2.20; p = 0.047) and radiotherapy (OR 2.22; p = 0.040). Loss of reconstruction was associated with a BMI >27.0 kg/m2 (OR 4.00; p = 0.012), tobacco use (OR 6.64, p = 0.006), and higher tissue expander volume (p = 0.035). Similarly, readmission was associated with higher tissue expander volume (p = 0.042). In conclusion, a variety of factors were identified to be associated with major complications, including higher BMI, increased tissue expander volume, as well as history of chemotherapy and radiation. This information is valuable for pre‐operative counseling and for future comparative studies between different ADM types.

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“…Furthermore, ADM elicits no immune responses because it does not express any major histocompatibility antigens, either class I or II. With these advantages, ADM is widely used in breast reconstruction, [13] hernia repair, plastic surgery, such as rhinoplasty [14] and lip augmentation, [15] and penile surgery. Phalloplasty with ADM resulted in satisfactory penile augmentation with minimal morbidity.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment for primary premature ejaculation with an inner condom technique

Wang¹,

Bai

Zhang

et al. 2019

Medicine

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To explore a novel surgical treatment for primary premature ejaculation using an inner condom technique.A total of 20 males with premature ejaculation, who admitted our andrology clinic from June 2016 to July 2017, were enrolled. By surgery, an inner condom made of acellular dermal matrix (ADM) was transferred to the subcutaneous pocket of the penis. The prolongation of intravaginal ejaculatory latency time (IELT) after the surgery was examined. The perioperative complications were also studied.The surgical intervention significantly increased the average IELT in patients, from 0.67 to 2.37 min (P = .009). No serious perioperative complications and adverse psychosexual effects were seen. Patients could resume sexual activity 6 weeks after the surgery.The novel inner condom using ADM is an effective and safe surgical treatment for males with premature ejaculation. The efficacy of this new treatment modality warrants further investigation in independent cohorts.

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Acellular Dermal Matrix for Reoperative Breast Augmentation

Cited by 58 publications

References 38 publications

Lateral and Inferior Implant Malposition in Prosthetic Breast Reconstruction: Incidence and Risk Factors

Lateral and Inferior Implant Malposition in Prosthetic Breast Reconstruction: Incidence and Risk Factors

Identifying risk factors for postoperative major complications in staged implant‐based breast reconstruction with AlloDerm

Surgical treatment for primary premature ejaculation with an inner condom technique

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