Abstract
The aim of the study was to show significant differences regarding postoperative complications and outcomes using three different Acellular Dermal Matrices (ADM), namely Epiflex®, Strattice® and Braxon®, in immediate implant-based subpectoral breast reconstruction cases. Background: The use of Acellular Dermal Matrices for implant-based breast reconstruction cases continues to evolve. There is a wide variety of products which differ significantly in their biological features. It remains unclear if and how these differences manifest in clinical practice. Methods: 82 cases of primary breast reconstruction in the Department of Plastic and Aesthetic Surgery of HELIOS Clinics Schwerin, Germany between 2010 and 2018 were analyzed. 25 patients received Strattice® acellular dermal matrix (SADM), 22 cases Epiflex® acellular dermal matrix (EADM) and the remaining 35 cases Braxon® acellular dermal matrix (BADM). The mean follow-up was 1.8 years. Cases were analyzed regarding minor or major complications and rate of capsular contracture grade III or IV (Baker Classification). Results: The overall complication rate was 34.1% for all groups (SADM = 40%, EADM = 50%, BADM = 20%, p-value = 0.051). Of all cases, 6 patients underwent implant exchange or secondary autologous reconstruction due to capsular contracture (7.3%). The mean time between revision due to capsular contracture and reconstruction was 35.8 ± 14.4 months. 50% of patients, who developed capsular contracture, received postoperative radiation. Mean hospitalization time was 8.2 ± 3 days (SADM = 8 ± 3.2 days, EADM = 10 ± 2.8 days, BADM = 6 ± 1.3 days). There were no significant differences between all three groups for demographics, overall complication rate or capsular contracture. However, patients receiving Braxon® matrix showed significantly fewer minor complications (p-value = 0.01). Moreover, patients receiving Braxon® ADM showed a significantly lower time of hospitalization (p ® ADM showed significantly lower minor complication rates and hospitalization time. In addition, these matrices showed a trend towards lower capsular contracture rates. The low rate of capsular contracture hints at possible advantages of ADM-use in direct-to-implant cases.
Highlights
There is widespread application of Acellular Dermal Matrices (ADM) for direct-to-implant (DTI) breast reconstruction
We included all patients who were diagnosed with ductal carcinoma in situ (DCIS), invasive breast cancer and in whom skin-sparing or nipple-sparing mastectomy has been indicated as consented by the interdisciplinary tumor conference of the institution
Patients were clustered into the Strattice® (SADM), Epiflex® (EADM) or Braxon® (BADM) group according to the ADM
Summary
There is widespread application of Acellular Dermal Matrices (ADM) for direct-to-implant (DTI) breast reconstruction. The reasons for this are mainly: 1) artificial elongation of the pectoralis muscle, which limits muscle dissection and surgical trauma and allows for increased initial fill volumes and faster expansion in expander-based cases [1]; 2) provision of an additional protection layer by enhancement of the soft tissue [2]; 3) better control of the inframammary fold and implant migration and the ability to shape the implant pocket, resulting in superior aesthetic outcomes [3] [4]; 4) possibly lower rates of capsular contracture, especially in the case of post-mastectomy radiation therapy (PMRT) [5]. It is yet unknown if and how these experimental findings and different biological properties manifest in clinical practice
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