Immediate Single-Stage Breast Reconstruction Using Implants and Human Acellular Dermal Tissue Matrix With Adjustment of the Lower Pole of the Breast to Reduce Unwanted Lift

Abstract

Breast reconstruction using implants remains an aesthetic challenge toward achieving symmetry and natural appearance. Closing the areolar defect results in a vertically elevated breast mound. The use of human acellular dermal tissue matrix has been reported to provide coverage and durability over breast implants while allowing for improved shape of the reconstructed breast. This study reports the operative technique used in a series of breast reconstructions using saline implants and human acellular dermal tissue matrix in an immediate one-stage procedure. Complications and appearance were evaluated for all reconstructions. Indications for inframammary fold reconstruction and lower pole breast enhancement using chest skin advancement were discussed. Twenty-three patients were included in the study; 11 had unilateral reconstruction and 12 had bilateral reconstruction for 35 total reconstructions. All patients had immediate reconstruction following skin-sparing mastectomy. Nine patients had inframammary fold reconstruction and 11 patients had a lower chest advancement flap with fold reconstruction. The mean follow-up was 9.5 months with a range of 1 to 24 months. Complications occurred in 3 patients. Human acellular dermal tissue matrix can successfully be used in conjunction with breast implants to achieve an aesthetically pleasing breast reconstruction in one stage at the time of skin-sparing mastectomy. The use of a tissue expander and its associated risks and costs are eliminated. The complication rate is low. In addition, either inframammary fold reconstruction or lower chest advancement and fold reconstruction to augment lower pole skin coverage can improve symmetry with the opposite breast.

Acellular Dermal Matrix for Optimizing Outcomes in Implant-Based Breast Reconstruction: Primary and Revisionary Procedures

“…Two patients required revisionary surgery; one patient underwent implant exchange as she desired a larger implant and the other underwent nipple reconstruction to regain nipple projection after nipple flattening. Our results suggest that ADM-assisted direct-to-implant breast reconstruction can be reliably accomplished after NASM and are in concordance with other published series of ADMassisted direct-to-implant reconstruction (Breuing & Warren, 2005;Breuing & Colwell, 2007;Cassileth et al, 2011;Salzberg, 2006;Salzberg et al, 2011;Topol et al, 2008;Zienowicz & Karacaoglu, 2007).…”

“…Immediate direct-to-implant breast reconstruction after skin-sparing or NASM (Breuing & Warren, 2005;Breuing & Colwell, 2007;Cassileth et al, 2011;Salzberg, 2006;Salzberg et al, 2011;Topol et al, 2008;Wang et al, 2008;Zienowicz & Karacaoglu, 2007) is gaining popularity as a viable alternative to immediate expander/implant reconstruction which is the current standard of care for implant-based breast reconstruction postmastectomy (American Society of Plastic Surgeons [ASPS], 2009). While both approaches allow immediate creation of the breast mound offering pyschologic and aesthetic benefits, the direct-to-implant approach allows maximal use of the preserved mastectomy skin at the time of reconstruction.…”

Macrophage phenotypes correspond with remodeling outcomes of various acellular dermal matrices

“…These products are all composed of extracellular matrix (ECM) but differ in species of origin, tissue source, processing methods and/or extent of chemical crosslinking. They have been used for a number of applications, first with burns [1,2], but more recently with cosmetic [3,4] and reconstructive procedures [5,6], notably breast reconstruction [7,8].…”

Acellular dermal matrix fenestrations and their effect on breast shape

“…ADMs serve several functions when utilized in breast reconstruction. Most notably, they provide greater soft tissue coverage and suspension within a pocket that may allow for direct-toimplant reconstruction and decrease the time needed to achieve complete expansion in two-stage reconstructions [3][4][5]. Additionally, when sutured to the chest wall, ADMs can accentuate the infra-mammary fold and lend definition to the lateral mammary contour, which improves symmetry and aesthetic appeal [6][7][8].…”