Volume replacement with diced acellular dermal matrix in oncoplastic breast-conserving surgery: a prospective single-center experience

Abstract

Background: Several studies have reported the use of acellular dermal matrix in breast reconstruction. However, the primary role of acellular dermal matrix in these studies was to support the implant; there are no reports on the use of acellular dermal matrix exclusively as volume replacement. Thus, we aimed to evaluate the safety and effectiveness of filling of the defect with acellular dermal matrix in oncoplastic breast-conserving surgery. Methods: We prospectively recruited 120 adult breast cancer patients who were scheduled to undergo oncoplastic breast-conserving surgery with acellular dermal matrix filling from 2017 to 2018. Intraoperatively, diced human acellular dermal matrix measuring 3-5 mm was used on each side to fill in the excisional defect immediately. After 6 months, satisfaction of the patients and surgeons with overall and cosmetic outcomes was evaluated with a survey using a 10-point scale. Postoperative complications were assessed at 2 weeks and 6 months postoperatively. Results: Of the 117 patients who were evaluated for their satisfaction, 94.0% were strongly satisfied with the cosmetic outcomes and 90.4% were strongly satisfied overall. Patient overall satisfaction scores were higher than surgeon satisfaction scores (p < 0.001). Of the 117 patients who underwent evaluation of complications 6 months postoperatively, six (5.1%) had hematoma and seven (6.0%) had seroma. The overall reoperation rate due to complications was 8.5%. Only two patients needed acellular dermal matrix removal due to hematoma and inflammation. Conclusion: Oncoplastic breast-conserving surgery with acellular dermal matrix filling of defects can be performed safely with high cosmetic satisfaction.

The Comparison of Breast Reconstruction Using Two Types of Acellular Dermal Matrix after Breast-Conserving Surgery

“…The ADM is used for implant wrapping in nipple-sparing mastectomy and skin-sparing mastectomy nowadays, and has already secured stability. However, the method of BCS reconstruction using the ADM is rarely known [ 23 , 24 ]. There was no comparison according to ADM type during BCS surgery before.…”

Imaging surveillance for the detection of ipsilateral local tumor recurrence in patients who underwent oncoplastic breast-conserving surgery with acellular dermal matrix: abbreviated MRI versus conventional mammography and ultrasonography

“…In breast surgery, ADM is used in more than 75% of immediate tissue expander reconstruction procedures to support the implant [ 13 ]. ADMs are increasingly utilized in BCS for volume replacement, and recent reports show satisfactory results regarding their safety and cosmetic outcome over a short-term follow-up period [ 14 – 16 ]. However, concern still exists regarding the influence of postoperative changes by ADM on monitoring local tumor recurrence (LTR) on postoperative imaging surveillance [ 16 , 17 ].…”

Acellular dermal matrix as filler in breast-conserving surgery: warnings for a careful use

“…The evaluation of cosmetic outcomes, 6 months after surgery using a scoring system (0-10 points), documented very positive results, with an average score for overall satisfaction of 9.4 in the patient group and 9.5 in the surgeon group [1].…”

“…Gwak and colleagues reported a 5.1% rate of hematoma, 6.0% of seroma, and 2.5% of red breast syndrome in the 117 breast cancer patients who underwent BCS with ADM; seroma and hematoma accounted for 54.2% of all their complications. In addition, they experienced a significant overall reoperation rate due to complications in 8.5% of their patients; two cases required ADM excision due to hematoma and inflammation [1].…”

“…-Careful patient assessment to select the best candidates to BCS with ADM; patients with specific medical comorbidities, active smoking, noncontrolled diabetes mellitus or treated with neoadjuvant chemotherapy should not be considered for use of ADM as a filler due to higher risk of postoperative infections. Moreover, fibrogenetic action induced by diced ADM and its partial reabsorption can determine peculiar radiological findings on postoperative imaging; in the study of Gwak et al, mammography showed ADM as a mass with well-circumscribed margins [1]; ultrasonography revealed that diced ADM had the same echogenicity as fibroglandular parenchyma presenting a peculiar image similar to that reported using oxidized regenerated cellulose as a filler in BCS [1,5,6]; a rim-enhancing mass was found around the ADM on contrast-enhanced MRI that needed core needle biopsy in order to obtain a detailed diagnosis [1]. These peculiar radiological findings can lead to undue alarmism and misdiagnosis during the follow-up of breast cancer patients if not properly interpreted.…”