One-step prepectoral breast reconstruction with porcine dermal matrix-covered implant: a protective technique improving the outcome in post-mastectomy radiation therapy setting

Abstract

Background: Post-mastectomy radiotherapy (PMRT) applied on implant-assisted immediate breast reconstruction (IBR) involves a marked increase in complication rate. The recent opportunity of performing an ADM-assisted prepectoral breast reconstruction (PPBR) raised the hypotesis of a protective interaction between ADM and periprosthetic tissues under PMRT.Methods: We performed a retrospective monocentric analysis of a cohort of consecutively treated patients undergone one-step PPBR between January 2015 and September 2018. The aim is to examine complication rate and aesthetic satisfaction of patients, in order to evaluate if this reconstructive technique could be recommendable in PMRT setting. Group 1 comprised 158 patients not submitted to PMRT and Group 2 twenty-eight patients undergone PMRT.Results: All post-operative complications were not statistically different between the two groups, except for capsular contracture (P=0.011). We obtained very high percentages in all BREAST-Q categories in Group 2 patients: satisfaction with breasts 86.8±13.9, satisfaction with implants 6.5±3.0, high satisfaction for no adverse effects of radiation 15.7±6.8. According to multivariate analysis no risk factor was significantly associated with complications. Conclusions:We may conclude that one-step PPBR with porcine ADM followed by PMRT is well tolerated, with no significant risk of adverse outcomes, at least in the short-term follow-up. These promising outcomes warrant further studies to examine the existence of a protective effect due to ADM integration with subcutaneous tissue.

The Journey of Prepectoral Breast Reconstruction through Time

“…They found no significant risk of implant loss 1.1% vs 3.6%, rippling of 0.6% vs 0, seroma 8% vs 7.1%, and infection 5.2% vs 0 between the two groups. However, the capsular contracture rate was higher in the PMRT group, 10.7% compared to non-PMRT group 0.6%, which was statistically significant 37,38 . In comparison, the effect of PMRT in patients who had subpectoral implant-based breast reconstruction versus prepectoral one, contracture rate was significantly higher for the subpectoral patients with PMRT than for the prepectoral patients with PMRT (52.2 vs 16.1%; P=0.0018) 24 .…”

“…In patients with Prepectoral breast reconstruction with ADM's or synthetic mesh with postmastectomy radiotherapy, we found studies to be in favour of use of radiotherapy 31,37,38 . Prepectoral breast reconstruction group had minimal or comparable complication rates (25% in irradiated vs 23% in the non-irradiated group) compared with the subpectoral group (Table 2).…”

“…One-step PPBR with porcine ADM followed by PMRT is well tolerated with no significant risk of adverse outcomes, in the short-term follow-up 38 .…”

“…Upon subgroup analysis, the reported higher rates of capsular contractures in some studies has significantly reduced over time, with the use of ADM. We noted the average capsular contracture rates in partial wrap ADM to be lower(3.6%) than in full wrap ADM use (5.2%) which in comparison to the Tiloop R mesh is around 4% 8,30 . Surgeons' experience and knowledge of understanding of prepectoral anatomy has significantly evolved over time 15,24,30,38 . We also noted major complications such as the implant loss rates 10,19,25,26,31,32 in a range of 0%-18% between two groups with average Implant loss rate to be around 5.2% with the ADM and 3%-3.5% in the synthetic mesh group.…”

Tissue-Material Integration and Biostimulation Study of Collagen Acellular Matrices

“…According to the literature, the stimulation and differentiation of ASCs increase wound repair and regeneration ability by intensifying collagen secretion and deposition [9,14]. Recent studies have demonstrated a link between adipocytes and wound healing, given that adipocytes also act as key regulators of skin health [28]. Collected data showed that in vitro colonisation capacity and adipogenic differentiation potential of ASCs are membrane dependent.…”