Abstract
Purpose The acellular dermal matrix plays an important role in reinforcing thin mastectomy skin and repositioning the implant in prosthetic breast reconstruction. As the concept of prepectoral plane has become widespread, the role of the acellular dermal matrix has become increasingly important. However, evidences and standards for appropriate thickness and direction during placement remain insufficient. This study is aimed at testing the assumption that differences in the acellular dermal matrix thickness and orientation during placement may affect surgical outcomes including the incidence of postoperative complications. Methods This was a retrospective single-centered analysis of 43 patients (50 breasts) who underwent implant-based reconstruction with MegaDerm® (L&C Bio, Seoul, Korea) and 23 patients (23 breasts) who underwent implant-based reconstruction with DermACELL® (LifeNet Health, Virginia Beach, VA, USA), two types of human-derived acellular dermal matrix. All surgeries were performed by a single surgeon. Demographic variables, surgery-related factors, and complications were compared between a thick matrix group (1.5–2.3 mm) and a thin matrix group (1.0–1.5 mm). The same processes were performed in the nonreverse and reverse matrix insertion groups. Results Baseline demographics and surgery-related data were summarized according to matrix thickness and direction. There were no significant intergroup differences in the demographic variables such as history of smoking, radiation, or chemotherapy. The mean drain volume was significantly higher in the thick matrix group than that in the thin matrix group (p = 0.0445). However, there were no significant differences in overall complication rates by matrix thickness (p = 0.3139). Additionally, there were no significant differences in complications between the nonreverse and reverse matrix insertion groups (p = 0.538). Conclusion Our findings suggest that patients with a thick acellular dermal matrix need a prolonged period for engraftment. However, the thickness did not directly affect the surgical outcomes between the thick and thin matrix groups. Likewise, the orientation in which the acellular dermal matrix was inserted did not affect the surgical outcomes including postoperative complications.
Highlights
Acellular dermal matrix (ADM) is a tissue graft processed from cadaver, animal, or synthetic materials
There were no significant differences between the patients in the thick and thin ADM groups regarding mean age, body mass index, smoking history, obesity, history of chemotherapy, or history of radiotherapy (Table 1)
There were no significant differences between the thick and thin ADM groups in surgery-related factors including time to drain removal, operation site, mastectomy type, implant insertion plane, implant texture, or axillary lymph node dissection (Table 2)
Summary
Acellular dermal matrix (ADM) is a tissue graft processed from cadaver, animal, or synthetic materials. ADM is commonly used in prosthetic breast reconstruction for its pliability, strength, tissue integration, and potential role in the mitigation of capsular contracture [1]. The use of ADM in breast reconstruction is gradually expanding [3, 4]. Using ADM, the thickness of the mastectomy flap can be reinforced, the position of the implant is stabilized, and complications such as capsular contracture can be reduced [5,6,7,8,9,10]. As the use of ADM increases and the concept of prepectoral breast reconstruction becomes widely accepted in prosthetic reconstruction [11, 12], more drawbacks of ADM, such as seroma and infection of the engraftment issue, have been reported [13,14,15,16,17,18,19,20]. Since several types of ADM are available from porcine, bovine, ick ADM (1.5-2.3 mm) Breast implant
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