Early Complications after Prepectoral Tissue Expander Placement in Breast Reconstruction with and without Acellular Dermal Matrix

Abstract

Background: Prepectoral breast reconstruction has become popularized with the concurrent use of acellular dermal matrix (ADM). The authors sought to compare 3-month postoperative complication rates and explantation rates for first-stage, tissue-expander-based, prepectoral breast reconstruction with and without the use of ADM. Methods: A single-institution retrospective chart review was performed to identify consecutive patients undergoing prepectoral tissue-expander-based breast reconstruction from August of 2020 to January of 2022. Chi-square tests were used to compare demographic categorical variables, and multiple variable regression models were used to identify variables associated with 3-month postoperative outcomes. Results: The authors enrolled 124 consecutive patients. Fifty-five patients (98 breasts) were included in the no-ADM cohort and 69 patients (98 breasts) were included in the ADM cohort. There were no statistically significant differences between the ADM and no-ADM cohorts with regard to 90-day postoperative outcomes. On multivariable analysis, there were no independent associations between seroma, hematoma, wound dehiscence, mastectomy skin flap necrosis, infection, unplanned return to the operating room, or explantation in the ADM and no-ADM groups after controlling for age, body mass index, history of diabetes, tobacco use, neoadjuvant chemotherapy, and postoperative radiotherapy. Conclusions: The authors' results reveal no significant differences in odds of postoperative complications, unplanned return to the operating room, or explantation between the ADM and no-ADM cohorts. More studies are needed to evaluate the safety of prepectoral, tissue expander placement without ADM.

Tissue engineering strategies for breast reconstruction: a literature review of current advances and future directions

“…It has been demonstrated that acellular matrices undergo neo-vascularization and recellularization by host cells ( 19 - 21 ). In breast reconstruction, ADMs are used to enhance skin coverage, particularly after the placement of a silicone implant or tissue expander ( 4 , 22 ). Another goal is to reduce the risk of capsule contracture, a significant complication of implant-based surgeries, leading to a substantial decrease in the long-term cosmetic result ( 23 ).…”

“…Another goal is to reduce the risk of capsule contracture, a significant complication of implant-based surgeries, leading to a substantial decrease in the long-term cosmetic result ( 23 ). Some authors have described the risks associated with using ADMs, including infection rates, skin blisters, and overall complications ( 22 , 24 ). Some concerns were initially raised related to red breast syndromes found to be linked to ADMs by reconstructive surgeons ( 25 , 26 ).…”

Current Global Trends in Prepectoral Breast Reconstruction

“…However, it is important to note that there is still a need for larger and higher-quality studies that compare the technique of prepectoral breast reconstruction both with and without the use of ADMs in order to draw any definite conclusions [20].The latest research on prepectoral breast reconstruction without meshes is illustrated in Table 2. PPBR with and without mesh assistance found no difference between groups in hematoma, infection, or explanation rates, whereas capsular contracture and seroma rates were higher in the no-mesh cohort Piers et al [45] 2023 Found no significant differences in outcomes between prepectoral breast reconstruction with and without acellular dermal matrix Chen et al [46] 2023 PPBR with no biosynthetic scaffold had the lowest rates of capsular contracture and may provide the most optimal balance between economic and clinical considerations in implant-based reconstruction…”