Bovine Acellular Dermal Matrix–Based Breast Reconstruction in Previously Irradiated Breasts

Abstract

Radiation therapy is considered today an integral part of the management of breast cancer. However, radiotherapy significantly increases the incidence of total complications in breast reconstruction. Several procedures have been adopted to reduce complication rates in irradiated fields, including the use of acellular dermal matrices (ADMs). We conducted a retrospective analysis of our single-center experience with ADM-assisted implant-based reconstruction or revision surgeries for capsular contracture treatment in irradiated breasts. We divided our population into 4 groups based on prior surgical history: group A (previous quadrantectomy), group B (previous mastectomy and expander reconstruction), group C (previous mastectomy and implant reconstruction), and group D (prior quadrantectomy followed by mastectomy and implant reconstruction). At the European Oncology Institute in Milan, Italy, between June 2017 and April 2019, we identified 84 patients for a total of 86 irradiated breasts reconstructed with implant and ADM. We observed a total of 12 reconstructive failure, with the highest rate of failure in group B (16.6%) and in group D (15.38%). Overall, we recorded 22 total complications (24.4%): 12 major complications and 10 minor complications. The most common complication was infection, with 9 cases (10.4%), 6 of which were classified as severe and required implant removal. In group B, we observed the highest complication rate, both major and minor, with 7 of 42 patients (16.6%) experiencing each. Before reconstruction with ADM, the Baker grade ranged from 3 to 4, with a mean of 3.25. At the 2-year follow-up, the Baker grade ranged from 1 to 4, with a mean of 1.9. Surgeons were highly satisfied with the aesthetic result in 72.1% of cases, moderately in 8.1% and unsatisfied in 5.81%, and in 13.9%, the outcome was not assessable because of reconstructive failure. The worst aesthetic result was in group B. We observed significant reduction in capsular contracture in revision surgeries despite a moderately high rate of complications in previous quadrantectomy and radiotherapy. In our experience, breast reconstruction with implant and ADM is not the primary surgical indication in case of prior irradiation, but it can be considered as a valid alternative with reasonable safety profile, to be used in selected cases.

Single-Stage Immediate Breast Reconstruction with Acellular Dermal Matrix after Breast Cancer: Comparative Study and Evaluation of Breast Reconstruction Outcomes

“…The cause of such different results is unclear. Some authors [2,13,[33][34][35][36][37] suggest that most of the studies conducted on the effect of an ADM in the postoperative results were made with AlloDerm ® , which is a product that has been sold for longer, and only more recently, a series has been published with the use of other ADM, both from human and porcine origin, and although the preparation is similar in removing the cellularity of the tissue and infectious organisms, there may be subtle unpublished differences in the processing and storage of these products, causing an inflammatory response with a higher influence in the formation of seroma that could also be related to the increase in other complications such as infections or extrusions of the implant [34]. Reference is also made to important immunological differences between the matrices of human or non-human origin that can influence the rate of complications, preventing extrapolation of results from different studies [14,35,[38][39][40].…”

A Long-term Evaluation of Acellular Dermal Matrix for Immediate Implant-based Breast Reconstruction following Risk-reducing Mastectomy

“… 17 In other studies, the incidence of capsular contracture (Baker III/IV) ranged from 3.2% to 13.6%, which is lower compared with reported rates for submuscular IBR without ADM. 13 , 34 Lisa et al recently reported encouraging results concerning ADM-assisted revision surgery in irradiated breasts to prevent capsular contracture. 37 …”

“…17 In other studies, the incidence of capsular contracture (Baker III/IV) ranged from 3.2% to 13.6%, which is lower compared with reported rates for submuscular IBR without ADM. 13,34 Lisa et al recently reported encouraging results concerning ADM-assisted revision surgery in irradiated breasts to prevent capsular contracture. 37 RBS is characterized by transient cutaneous erythema over the ADM and is a well-known reaction associated with a reported incidence reaching up to 27%. 38 In our study, "breast redness" (41.1%) included both RBS and suspected or confirmed infections.…”