Complications following Nipple-Sparing Mastectomy and Immediate Acellular Dermal Matrix Implant-based Breast Reconstruction—A Systematic Review and Meta-analysis

Heidemann, Lene Nyhøj; Gunnarsson, Gudjon Leifur; Salzberg, C. Andrew; Sørensen, Jens Ahm; Thomsen, Jørn Bo

doi:10.1097/gox.0000000000001625

Cited by 35 publications

(25 citation statements)

References 32 publications

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“…A meta-analysis by Heidemann and colleagues reported complication rates of NSM with the use of AlloDerm Ready To Use (AlloDerm RTU; LifeCell, Branchburg, NJ, USA) as 9% necrosis or ischemia, 4% NAC necrosis or ischemia, 12% infection, 1% hematoma, 5% seroma, 4% explantation, and 9% unplanned return to the operating room. These rates are similar to that of NSM with reconstruction without the use of AlloDerm [ 2 ].…”

Section: Discussionsupporting

confidence: 76%

Persistent nipple discharge after nipple-sparing mastectomy secondary to unincorporated AlloDerm: a case report

Laarakker

Rich

et al. 2020

J Med Case Reports

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Background Rates of nipple-sparing mastectomies have increased over the past decade. In 2017, acellular dermal matrix was used in 56% of breast reconstructive procedures, with complication rates similar to operations without AlloDerm. Although persistent nipple discharge after nipple-sparing mastectomy is a rare event, it has been described in the literature. Other authors have described evaluation and treatment on a case-by-case basis. To the best of our knowledge, this is the first case report to describe a persistent unilateral discharge after multiple operative revisions and to provide an algorithmic approach to workup and treatment. Case presentation We present a case of a 29-year-old Hispanic woman with BRCA1 mutation who underwent a prophylactic bilateral nipple-sparing mastectomy with immediate reconstruction using AlloDerm. The year following her operation, the patient underwent two surgical revisions, one for implant rippling and one for asymmetry. Six months after her second revision, she presented to our hospital with a capsular contracture and unilateral clear nipple discharge. Her breast ultrasound showed dilated subareolar ducts and a suspicious mass. Magnetic resonance imaging identified a benign-appearing, rim-enhancing fluid collection. She underwent a third revision. One year later, she returned to our clinic with bloody nipple discharge, erythematous skin changes, and a palpable breast lump. Her surgical biopsy showed a fold in AlloDerm and chronic inflammatory changes. She continued experiencing discharge and opted for nipple excision. During the operation, a lacrimal probe demonstrated a direct connection between the discharging external duct and a seroma associated with an area of unincorporated AlloDerm. The section of unincorporated AlloDerm was excised, and no evidence of malignancy was identified. Ten months later, the patient remained symptom-free and had progressed to placement of final silicone implants. Conclusions To the best of our knowledge, this is the first case report to describe a nongravid patient with persistent unilateral sanguineous nipple discharge after multiple operative revisions. A visible communication between the draining duct and a seroma associated with unincorporated AlloDerm was ultimately identified. We present a clinical algorithm for patients with nipple discharge after nipple-sparing mastectomy.

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Section: Discussionsupporting

confidence: 76%

Persistent nipple discharge after nipple-sparing mastectomy secondary to unincorporated AlloDerm: a case report

Laarakker

Rich

et al. 2020

J Med Case Reports

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“…The present study compares the biological characteristics of different ACVM-0.25% HLC-I scaffold materials with Acellular Dermal Matrix (ADM) (26,27), Small Intestinal Submucosa (SIS) (28,29) and Bio-Gide scaffolds in tissue engineering. The aim of the present study was to confirm the advantages of ACVM-0.25% HLC-I composite scaffolds and lay a foundation for the research of tissue engineering scaffold materials.…”

Section: Introductionmentioning

confidence: 99%

Characterization of different biodegradable scaffolds in tissue engineering

et al. 2019

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The aim of the present study was to compare the characteristics of acellular dermal matrix (ADM), small intestinal submucosa (SIS) and Bio-Gide scaffolds with acellular vascular matrix (ACVM)-0.25% human-like collagen I (HLC-I) scaffold in tissue engineering blood vessels. The ACVM-0.25% HLC-I scaffold was prepared and compared with ADM, SIS and Bio-Gide scaffolds via hematoxylin and eosin (H&E) staining, Masson staining and scanning electron microscope (SEM) observations. Primary human gingival fibroblasts (HGFs) were cultured and identified. Then, the experiment was established via the seeding of HGFs on different scaffolds for 1, 4 and 7 days. The compatibility of four different scaffolds with HGFs was evaluated by H&E staining, SEM observation and Cell Counting Kit-8 assay. Then, a series of experiments were conducted to evaluate water absorption capacities, mechanical abilities, the ultra-microstructure and the cytotoxicity of the four scaffolds. The ACVM-0.25% HLC-I scaffold was revealed to exhibit the best cell proliferation and good cell architecture. ADM and Bio-Gide scaffolds exhibited good mechanical stability but cell proliferation was reduced when compared with the ACVM-0.25% HLC-I scaffold. In addition, SIS scaffolds exhibited the worst cell proliferation. The ACVM-0.25% HLC-I scaffold exhibited the best water absorption, followed by the SIS and Bio-Gide scaffolds, and then the ADM scaffold. In conclusion, the ACVM-0.25% HLC-I scaffold has good mechanical properties as a tissue engineering scaffold and the present results suggest that it has better biological characterization when compared with other scaffold types.

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“…The formation of a seroma is the most common adverse event in the setting of an ADM with an incidence that ranges from 5% to 12% based on studies that did not mention RBS 22–25 and an incidence ranging from 0% to 24% with a mean of 4.9% based on studies that did mention RBS (Table 1). Seromas can be clinically evident and manifest as a fluid wave or subclinically without any external evidence.…”

Section: Prosthetic Reconstruction With Admmentioning

confidence: 99%

Prosthetic Breast Reconstruction and Red Breast Syndrome: Demystification and a Review of the Literature

Nahabedian

2019

Plastic and Reconstructive Surgery - Global Open

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Complications following Nipple-Sparing Mastectomy and Immediate Acellular Dermal Matrix Implant-based Breast Reconstruction—A Systematic Review and Meta-analysis

Abstract: Supplemental Digital Content is available in the text.

Cited by 35 publications

References 32 publications

Persistent nipple discharge after nipple-sparing mastectomy secondary to unincorporated AlloDerm: a case report

Persistent nipple discharge after nipple-sparing mastectomy secondary to unincorporated AlloDerm: a case report

Characterization of different biodegradable scaffolds in tissue engineering

Prosthetic Breast Reconstruction and Red Breast Syndrome: Demystification and a Review of the Literature

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