Direct‐to‐implant, prepectoral breast reconstruction with Braxon ^® dermal matrix: A single‐center experience with 111 cases

Novel three-dimensional acellular dermal matrix for prepectoral breast reconstruction: First year in review with BRAXON®Fast

“…BRAXON® Fast is then meant to be fixed both at the pectoralis fascia and at the subcutaneous tissue to obviate malposition and rotation of the implant. Moreover, the experience of Mura et al reports that fixing the matrix to the subcutaneous tissue can be an effective way to obliterate spaces and prevent the accumulation of inflammation-derived fluids resulting from the surgical insult of mastectomy ( 24 ). In our center, this practice has been applied since the very early cases with BRAXON® total implant coverage, and in this case series, the small number of seroma occurrences (one breast) counts for the 3.7% of all treated breasts.…”

Braxon®-assisted prepectoral breast reconstruction: A decade later

“…An additional important procedure consists in stitching the anterior side of the dermal matrix to the subcutaneous tissue with quilting sutures using absorbable 2–0 or 3–0 Vicryl stitches ( 32 ). Multiple benefits derive from this procedure: it reduces dead spaces and consequently decreases the risk of fluid collection, thereby preventing seroma formation; it ensures intimate contact of the matrix with viable subcutaneous tissues, allowing proper matrix integration and tissue regeneration; it guarantees the mechanical stillness of the implant and prevents frictions that can cause inflammation and hinder matrix integration ( 32 , 33 ). An additional tip provided by many authors is prescribing the patient to wear a sport bra starting from 2 days after surgery and for at least 1 month ( 34 ).…”

“…The breast subcutaneous tissue is the key player in PPBR because it must provide the cells that will repopulate the ADM and use it as a regenerative scaffold. Proper matrix integration is an essential step in limiting postoperative complications ( 33 , 44 , 45 ). Hereby, it is extremely important to preserve tissue viability and vascularization, avoiding, where possible, all those intraoperative procedures during mastectomy and reconstruction that could impair it.…”

“…Most authors suggest performing an ADM-assisted PPBR on patients selected with strict criteria: non- or ex-smokers, non-obese (BMI < 30 kg/m 2 ) people with a history of undergoing a considerable number of preoperative pinch tests (>1 cm), without a history of or planned RT, limited implant volume, and no comorbidities, especially if impairing vascularization. In addition to optimal skin quality, only mild to moderately ptotic breasts of small to medium size and subjected to a nipple- or skin-sparing mastectomy are generally considered for DTI PPBR ( 25 , 29 , 33 , 49 , 53 ). In addition, inflammatory tumors and skin invasion are considered contraindications ( 49 ).…”

“…Overall, clinical experience shows low incidences of seroma, mostly in line with good clinical practice. According to expert users of Braxon®, however, fluid accumulation can be prevented by (i) minimizing intra- and postoperative inflammation ( 44 , 114 , 115 ), (ii) obliterating postmastectomy dead spaces ( 44 , 111 , 113 ), and (iii) ensuring intimate tissue contact and mechanical stability of the ADM to facilitate its integration ( 33 , 44 ).…”