Two-Stage Prosthetic Breast Reconstruction Using AlloDerm Including Outcomes of Different Timings of Radiotherapy

Spear, Scott L.; Seruya, Mitchel; Rao, Samir S.; Rottman, Steven J.; Stolle, E; Cohen, Michael J.; Rose, Kirsten; Parikh, Pranay M.; Nahabedian, Maurice Y.

doi:10.1097/prs.0b013e3182547a45

Cited by 121 publications

(78 citation statements)

References 35 publications

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“…In the published studies the contracture rate varied between 0-60% (9,12,13,18,(24)(25)(26)(27)(28) and 0-3% for non-irradiated breasts (12,25,26).…”

Section: Discussionmentioning

confidence: 99%

“…CC was graded using the conventional Spear-Baker classification for non-irradiated breasts (30). A modified version of this classification in irradiated breasts (26). Grade III and IV CC were determined as clinically significant CC according to the literature.…”

Section: Data Collection and Analysismentioning

confidence: 99%

“…Because ADMs appear to mitigate the risk of CC, the natural question is whether these matrices also reduce the risk in the setting of radiotherapy. Data on the incidence of CC in the setting of radiotherapy in ADM-assisted reconstructions are, however, limited with short follow up times (9,12,13,18,(24)(25)(26)(27)(28). Salzberg recently published a long-term follow-up (13 years) with low CC rate even after radiotherapy (1.9%) when ADM is used in one-stage implant based BR (28).…”

Section: Introductionmentioning

confidence: 99%

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Capsular contracture in implant based breast reconstruction—the effect of porcine acellular dermal matrix

Lardi

Ho-Asjoe

Junge³

et al. 2017

Gland Surg.

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Background: Irradiation of implant-based breast reconstructions (BR) is known to increase capsular contracture (CC) rates on average by 4-fold over non-irradiated reconstructions. The use of acellular dermal matrix (ADM) has been associated with lower CC rates in non-irradiated reconstructions (0-3%).Experimental and clinical studies suggest that ADM may also reduce CC rates in irradiated breasts. The aim of this study was to evaluate CC rates in non-irradiated and irradiated one-and two-stage BRs performed with the assistance of porcine ADM (PADM).Methods: A single centre, retrospective, cohort study was designed from December 2008 to October 2012.A total of 200 immediate implant-based BRs were performed using PADM for inferior pole reinforcement.We included non-irradiated BR with a minimum follow up of 6 month from primary surgery (one stage) or from explantation of expander and implantation of the definitive implant (two stage). Of the postoperatively irradiated BR we included patients with 1 year or more follow up time from termination of radiotherapy.CC was graded using the conventional Spear-Baker classification and modified version for irradiated BR.According to the literature Grade III and IV CC were defined as clinically significant CC. Results: Of 200 BRs with PADM, 122 were included in this study (84 non-irradiated and 38 irradiated).Sixty-five BR were one stage and 57 were two stage BR. Grade III/IV CC was remarkable low in nonirradiated (6%) and irradiated BR (13%). There was a non-significant trend to increased Grade III and IV CC in irradiated BR vs. non-irradiated BR (13% vs. 6%, P=0.216). In this study follow up time (P<0.001) and the stage of ADM reconstruction (two vs. one stage, P=0.022) were significant risk factors for occurrence of grade III/IV CC on univariate analysis and remained significant for the follow up time (P=0.013) and remarkable for the stages (P=0.093) in multivariate analysis. Conclusions:Our data support the current clinical evidence that ADM use in implant-based BR is associated with a reduced risk of CC when compared to the standard submuscular techniques in literature.The reduced risk is maintained in the setting of radiotherapy. Two stage procedures in our study population showed increased grade III/IV CC compared to one stage procedures with or without exposure to radiation.

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“…In the published studies the contracture rate varied between 0-60% (9,12,13,18,(24)(25)(26)(27)(28) and 0-3% for non-irradiated breasts (12,25,26).…”

Section: Discussionmentioning

confidence: 99%

Section: Data Collection and Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Capsular contracture in implant based breast reconstruction—the effect of porcine acellular dermal matrix

Lardi

Ho-Asjoe

Junge³

et al. 2017

Gland Surg.

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show abstract

“…Compared with the rates of capsular contracture in one of the larger studies comparing capsular contracture rates between 337 acellular dermal matrix (208 breasts) and non-acellular dermal matrix (129 breasts) in breast reconstructions, our rates are slightly lower (3.8% vs. 3.4%) [14]. Of three breasts with grade II capsular contracture, two (66.6%) received radiotherapy which has been possibly associated with an increased rate of capsular contracture, regardless of acellular dermal matrix use [20].…”

Section: Discussionmentioning

confidence: 91%

The Effect of Acellular Dermal Matrix in Implant-Based Immediate Breast Reconstruction with Latissimus Dorsi Flap.

Park

Shin

et al. 2017

Arch Aesthetic Plast Surg

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“…Of the four breasts with grade II capsular contracture, two (50 percent) received radiation therapy, which has been demonstrated to increase the degree of capsular contracture in two-stage reconstructions, regardless of acellular dermal matrix use. 29,30 Whether matrices are efficacious in decreasing capsular contracture in the irradiated field remains to be determined. They have been shown to limit the histologic changes seen around implants after irradiation, and preliminary studies have shown favorable clinical and histologic results.…”

Section: Discussionmentioning

confidence: 99%

Capsular Contracture in Implant-Based Breast Reconstruction

Mowlds

Salibian

Scholz

et al. 2015

Plastic and Reconstructive Surgery

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Two-Stage Prosthetic Breast Reconstruction Using AlloDerm Including Outcomes of Different Timings of Radiotherapy

Abstract: Therapeutic, III.

Cited by 121 publications

References 35 publications

Capsular contracture in implant based breast reconstruction—the effect of porcine acellular dermal matrix

Capsular contracture in implant based breast reconstruction—the effect of porcine acellular dermal matrix

The Effect of Acellular Dermal Matrix in Implant-Based Immediate Breast Reconstruction with Latissimus Dorsi Flap.

Capsular Contracture in Implant-Based Breast Reconstruction

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