Outcome of complete acellular dermal matrix wrap with polyurethane implant in immediate prepectoral breast reconstruction

Abstract

Background Polyurethane implants have been used on and off in breast reconstruction since 1991 while prepectoral breast reconstruction has gained popularity in recent times. In this study, we present our outcomes from the use of acellular dermal matrix (ADM) complete wrap with polyurethane implants in prepectoral breast reconstruction.Methods This is a retrospective review of prospectively maintained database from 41 patients receiving complete ADM wrap with prepectoral polyurethane implants over a 3-year period. Selection criteria were adapted from a previous study (4135 Trust Clinical Audit Database) evaluating prepectoral reconstruction with Braxon matrices. Patient demographics, operative data, surgical complications, and outcomes were collected and analyzed.Results A total of 52 implant reconstructions were performed in 41 patients with a mean follow-up of 14.3 months (range, 6–36 months). The overall reported complication rates including early (less than 6 weeks) and late complications. Early complications included two patients (4.9%) with wound dehiscence. One of which had an implant loss that was salvageable. Another patient (2%) developed red-breast syndrome and two women (4.9%) developed with seroma treated conservatively. Late complications included one patient (2%) with grade II capsular contraction, 12 patients with grade I-II rippling and two patients (4.9%) with grade III rippling.Conclusions We present our experience of prepectoral polyurethane implant using complete ADM wrap. This is one of the few papers to report on the outcome of the prepectoral use of polyurethane in immediate implant-based breast reconstruction. Our early observational series show satisfactory outcome and long-term results are warranted by a large multicenter study.

Comparing Polyurethane and Acellular Dermal Matrix Implant Cover in Prepectoral Breast Reconstruction: Short-term Complications

“…Meshes are another option for prepectoral breast reconstruction, and these were not analyzed herein. The use of an ADM wrap concomitantly with PU-coated implants has recently been reported, 17 as has the use of implants without any further coverage. 14 A head-to-head comparison between these many interface materials and the use of implants alone is warranted to clarify the true short and long-term benefits of each.…”

Braxon®-assisted prepectoral breast reconstruction: A decade later

“…Beyond the issues already discussed exhaustively here, this porcine-derived matrix collects extremely heterogeneous clinical experiences such as implants in association with polyurethane prostheses ( 39 ), revision treatments ( 30 , 42 , 43 , 66 ), comparisons with other collagen-based scaffolds on the market ( 60 ), and also several publications that are now proposed to expand the selection criteria for elderly patients ( 46 , 71 ), skin-reducing surgeries ( 35 , 37 , 38 , 131 ), as well as risk-reducing operations ( 61 ).…”

“…When possible, the nipple–areola complex was harvested as a full-thickness skin graft and grafted back in the new position ( 37 ). The same technique has been used by other surgeons ( 35 , 38 , 39 ). In particular, Maruccia et al also performed quilting sutures between the ADM and the dermal flap ( 35 ).…”

“Tear-Drop Appearance” Wrap: A Novel Implant Coverage Method for Creating Natural Contour in Prepectoral Prosthetic-Based Breast Reconstruction

“…Acellular dermal matrix (ADM) was introduced in 2006 and is now widely used for PPBR, allowing implant coverage and support [ 10 , 11 , 12 ]. The use of ADM in PPBR has several advantages.…”