Evaluation of Xenograft Efficacy in Immediate Prosthesis-based Breast Reconstruction

Abstract

INTRODUCTION: The advent of acellular dermal matrix (ADM) has revolutionized prosthesis-based breast reconstruction, conferring soft tissue reinforcement to the mastectomy skin flap. However, paucity of human cadaveric tissue has resulted in limitation of supply and increased associated costs, prompting concerted effort to identify alternatives to human ADM, such as xenograft surgical adjuncts, to minimize cost burden to the patient and institution, while maintaining adequate soft tissue support. Although various studies have examined the safety of Artia, a porcine-derived ADM, in prosthesis-based breast reconstruction, few studies have evaluated its clinical efficacy as soft tissue reinforcement. This study uniquely compares clinical efficacy of Artia with AlloDerm, a commonly used human-derived ADM, by examining objective parameters of initial tissue expander (TE) fill volume at the time of mastectomy, number of TE fills, and time interval between exchange of TE for final implant. METHODS: IRB approved retrospective chart review was conducted to identify 273 consecutive TE-based procedures performed at a tertiary academic medical center between March 2017 and March 2021. Of these, 89 cases utilized Artia and 184 utilized AlloDerm. Univariate and binomial logistic regression analyses were conducted to compare patient characteristics and clinical endpoints between Artia and AlloDerm groups. RESULTS: Patients who underwent Artia-based breast reconstruction achieved comparable initial TE fill volume relative to those who underwent AlloDerm-based breast reconstruction (335 ± 198 mL versus 289 ± 158 mL, p = 0.10) and similar time interval to TE-implant exchange (232 ± 124 days versus 242 ± 131 days, p = 0.70) via univariate analysis. However, patients who underwent Artia-based reconstruction experienced fewer number of tissue expansions (3.92 ± 2.97 fills versus 4.99 ± 2.98 fills, p < 0.01). When normalizing for final implant size, which serves as a surrogate for body composition, the Artia group exhibited significantly higher perioperative fill (0.65 ± 0.34 v. 0.49 ± 0.19, p < 0.01). Rates of explantation were higher in the AlloDerm group; however, when controlling for confounding variables, no statistical significance was observed following binomial regression analysis. Otherwise, rates of post-operative complication were similar among groups. CONCLUSION: This study demonstrates efficacy of Artia as an alternative to human-derived ADM in immediate TE-based breast reconstruction. Demonstration of clinical efficacy of non-human cadaveric surgical adjuncts is of paramount importance to facilitate widespread acceptance of these materials and further decrease healthcare costs. This work, therefore, serves as a framework for future studies evaluating xenograft efficacy in breast reconstruction and can guide development of emerging biomaterials and techniques.