Comparison of Outcomes in Immediate Implant-Based Breast Reconstruction: Acellular Dermal Matrix versus Inferior Dermal Flap

Abstract

Background Implant-based breast reconstruction has evolved tremendously in the last decades, mainly due to the development of new products and techniques that make the procedure safer and more reliable. The purpose of this study was to compare the outcomes in immediate one-stage breast reconstruction between acellular dermal matrix (ADM) and inferior dermal flap (IDF). Methods We conducted a retrospective comparative study of patients submitted to immediate breast reconstructions with an anatomical implant and ADM or IDF in a single center between 2016 and 2018. Outcomes evaluated included major complications, early complications, reinterventions, readmissions, and reconstruction failure. Simple descriptive statistics and univariate analysis were performed. Results A total of 118 breast reconstructions (85 patients) were included in the analysis. Patients in the IDF group had a higher body mass index (median = 27.0) than patients in the ADM group (median = 24). There were no statistically significant differences among both groups regarding immediate major complication, early complications, readmissions, and reinterventions. Conclusion There are no significant differences in complications between the ADM and IDF approach to immediate implant breast reconstruction. In patients with higher body mass index and large, ptotic breasts, we recommend an immediate implant reconstruction with IDF.

Meshed Dermal Sling for Prepectoral Breast Reconstruction

“…In addition to reducing costs by eliminating need for any type of acellular dermal matrix, DS guarantees the supply of additional vascularized tissue to cover the implant. 3 , 8 , 9 It also expands indications for completely autologous prepectoral reconstruction, offering softer and more natural results to patients with medium-to-large breasts. 10 Finally, as originally described, covering the entire implant allows for greater predictability of implant placement and formation of a more homogeneous capsule with associated additional protection of a layer over the entire implant.…”

“…The possibility of offering more patients reconstruction with prepectoral implant and dermal sling without having to resort to acellular dermal matrix with reduced costs and less discomfort for the patient. follow-up time was 12 months (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). For single-stage reconstructions, average implant volume was 455 cm 3 (350-490); for two-stage reconstructions, average definitive implant volume was 465 cm 3 (395-560).…”

A Two-Year Retrospective Analysis of the Clinical Outcomes of Immediate Submuscular Breast Reconstructions With Native® Acellular Dermal Matrix

“…The first article reported low complications and natural aesthetic outcomes of the reconstructed breasts, along with complete matrix integration two months after surgery [ 12 ]. Additional and more recent studies show how, on large cohorts, Native®-assisted SBR has favourable outcomes not only when patients present risk factors (such as high BMI, old age, or tobacco use) [ 14 ], but also when this reconstructive technique is compared to autologous breast reconstruction with an inferior dermal flap, evidencing how Native® can compensate for the lack of autologous tissue [ 9 ].…”

“…Biological matrices are bioactive scaffolds that, for intrinsic structural and chemical properties, can interact with the natural body’s healing process and support tissue regeneration after surgical damage [ 8 ]. Their safety and efficacy in breast reconstruction have been widely studied and proven; similar reconstructive outcomes and complication rates were observed between patients reconstructed with ADM and with an autologous dermal flap [ 9 ]. Research in the bioengineering field has also highlighted the importance of having biomaterials that are tissue-specific for the implant site in order to obtain regenerative healing not only on the functional but also on the anatomical side [ 10 , 11 ].…”

“…Research in the bioengineering field has also highlighted the importance of having biomaterials that are tissue-specific for the implant site in order to obtain regenerative healing not only on the functional but also on the anatomical side [10,11]. Native® ADM (DECO med s.r.l., Marcon, Venice, Italy) is the only biomaterial specifically designed for subpectoral breast reconstruction, and literature data confirm its effectiveness in both clinical and aesthetic terms [9,[12][13][14]. However, the longterm results of a larger patient cohort have not yet been reported in the scientific literature.…”