Skin-reducing mastectomy and pre-pectoral breast reconstruction using the Braxon® ADM: a single-center experience

Abstract

Breast cancer is the second leading cause of death in women. The most recent and successful advancement in implant-assisted breast reconstruction after mastectomy is the prepectoral approach using an acellular dermal matrix (ADM). Patients with ptotic breasts and macromastia were initially excluded from this type of immediate reconstruction remaining a difficult group to treat. The aim of this paper is to present our experience in performing skin-reducing mastectomy with pre-pectoral implant and complete ADM coverage as a single-stage procedure in patients with large ptotic breasts, evaluating the benefits and complications resulting from the use of this technique. A retrospective analysis of skin-reducing mastectomies and pre-pectoral breast reconstructions using Braxon porcine-derived ADM performed between January 2019 and February 2021 at our Breast Unit. We treated 20 patients and performed a total of 24 skin-reducing mastectomies with pre-pectoral reconstruction. We observed two cases of partial NAC necrosis (8.3%) and one case of total NAC necrosis (4.2%). The incidence of skin flap necrosis was 8.3% (N.=2) healed by secondary intention. No case of prosthesis removal, infection or seroma was reported. Patients scored very good level of satisfaction with breast based on the results of the BREAST- Q questionnaire. Skin-reducing mastectomy and pre-pectoral breast reconstruction can be offered to patients with large and ptotic breasts with good aesthetic and functional results. New prospective observational studies would be desirable to provide an opportunity to evaluate the long-term capabilities and complications of this technique.