Immediate direct-to-implant breast reconstruction with acellular dermal matrix: Evaluation of complications and safety

Abstract

Objective: Immediate direct-to-implant breast reconstruction with acellular dermal matrix (ADM) is the method of choice for many plastic surgeons and patients, but the use of ADM remains a controversial subject in the literature. This study aimed to investigate complications, reconstructive failure and possible risk factors in directto-implant breast reconstruction with ADM (primarily Strattice™). Methods: We retrospectively examined all patients undergoing immediate direct-to-implant breast reconstruction with ADM, during a five-year period (2014e2019) at a university clinic. Study outcomes were all complications and explantations. Complications were stratified within and after 6 months postoperatively and subcategorized by type of intervention. Explantations were subcategorized into loss of implant or salvage with immediate insertion of a tissue expander, the same or a new implant. Results: We included 154 patients and 232 breasts. Complications within 6 months per patient included hematoma (4%), seroma (8%), infection (9%), necrosis, wound dehiscence and delayed wound healing (19%). The total complication rate per patient was 34%. Explantation occurred in 20 patients (13%) of which 9 (6% of all) had implant loss. Preoperative radiotherapy was a significant predictor of explantation (adjusted OR 4.9, 95% confidence interval (CI), 1.0e23.5; p ¼ 0.045), and smoking was also associated with risk of explantation, although only borderline significant (adjusted OR 4.0, 95% CI, 1.0e15.8; p ¼ 0.050). Conclusion:This study demonstrates acceptable rates of re-operations and implant loss compared to other studies but highlights the importance of proper patient selection with regards to risk factors to minimize complications.

Prophylactic treatment of breast implants with a solution of gentamicin, vancomycin and cefazolin antibiotics for women undergoing breast reconstructive surgery: protocol for a randomised, double-blind, placebo-controlled trial (The BREAST-AB trial)

“…Previous studies 26 suggest that surgical removal of the permanent implant can occur up to 1 year after the surgery, and therefore, this is included as a secondary outcome.…”

“…All-cause explantation of the breast implant within 1 year after the breast reconstruction surgery (Y/N) Previous studies 26 suggest that surgical removal of the permanent implant can occur up to 1 year after the surgery, and therefore, this is included as a secondary outcome.…”

Acellular dermal matrix in reconstructive surgery: Applications, benefits, and cost

“…Several surgical options are being employed for breast reconstruction surgery. The use of ADM in implant-based breast reconstruction following mastectomy has received a lot of attention recently (2,83,91,94,104,(107)(108)(109)(110)(111)(112). The advantages of ADM in implant-based breast surgery include implant stabilization, improved aesthetic outcomes, and reduced capsular contracture risks, donor site morbidity, and postoperative pain (34,83,86,109,(112)(113)(114).…”

Advances on the modification and biomedical applications of acellular dermal matrices

“…Since plastic surgery often involves the reformation, filling, or restoration of skin and other soft tissues, ADM materials have also been widely used in plastic surgery due to their unique advantages in soft tissue repair. A report from the American Society of Plastic Surgeons states that ADM was used in > 60% of all breast reconstructions performed in the USA in 2018 [97]. Immediate direct-to-implant breast reconstruction with ADM is the method of choice for many plastic surgeons and patients.…”

“…Among the reported benefits of ADM are the reduced risk of implant exposure and migration, a more satisfying definition of the inframammary fold, and reduction of the postoperative pain through the increase of the implant-pocket volume and the elimination of the need for coverage from surrounding muscles or fascia [98]. A study reported the acceptable rates of reoperations and implant loss of ADM after investigating the complications, reconstructive failure, and possible risk factors in direct-to-implant breast reconstruction with ADM (primarily Strattice ™ ) [97]. Moreover, breast reconstruction using ADM for the complete coverage of implants has been shown to reduce such complications and improve the aesthetic outcomes [99].…”