Acellular Dermal Matrices Research Articles

Acellular Dermal Matrices as an New Alternative for Treatment in Reproductive Organ Static Disorders: A Pilot Study.

Background: The study aimed to evaluate the clinical effects of utilizing acellular dermal matrix (ADM) for treating pelvic organ prolapse. The motivation behind exploring a new treatment method stems from the limited efficacy of current surgical options, which are often associated with side effects. Methods: Ten patients with reproductive organ prolapse underwent surgery at the Chair and Department of Gynecology, Obstetrics, and Gynecological Oncology in Katowice. ADM was used as a support material, with eight patients receiving double TOT and two undergoing a six-point fixation mesh procedure. Pelvic organ prolapse was evaluated pre-operatively and one month post-surgery using the Pelvic Organ Prolapse Quantification (POP-Q) System. General medical history and complaints were assessed using the short form (PFDIQ-SF20). The study included ten patients aged 39 to 71 (mean: 63.6 years), all with a history of at least one vaginal delivery (mean of two). None had undergone a cesarean section. Four patients exhibited POP-Q 3, and five had POP-Q 2. Results: The mean PFDIQ-SF20 score before surgery was 70.6 points. No major complications occurred during or after surgery. One patient experienced a vaginal fungal infection and an allergic reaction to sutures. Post-operation, ailments reduced by an average of 60.76 points, with five patients reporting no complaints. Conclusions: ADM emerges as a material of interest for gynecological surgery, with initial reports highlighting its effectiveness and optimistic safety profile. Further research is warranted to explore its potential as a promising option in pelvic organ prolapse treatment.

Soft Tissue Substitutes in Periodontal and Peri-Implant Soft Tissue Augmentation: A Systematic Review.

Different extracellular matrix (ECM)-based technologies in periodontal and peri-implant soft tissue augmentation have been proposed in the market. The present review compared the efficacy of soft tissue substitutes (STSs) and autogenous free gingival grafts (FGGs) or connective tissue grafts (CTGs) in mucogingival procedures to increase keratinized tissue (KT) width around teeth and implants. Two independent examiners performed an electronic search on MEDLINE and the Cochrane Library based on the following PICOS format: (P) adult patients; (I) soft tissue substitutes and FGGs/CTGs; (C) STSs vs. CTGs; STSs vs. FGGs; STSs vs control; (O) KT width gain; (S) systematic reviews, randomized controlled trials. Studies published before November 2023 were included. Around teeth, all biomaterials showed superior performance compared to a coronally advanced flap (CAF) alone for treating gingival recessions. However, when compared to CTGs, acellular dermal matrices (ADMs) yield the most similar outcomes to the gold standard (CTGs), even though in multiple recessions, CTGs continue to be considered the most favorable approach. The use of STSs (acellular matrix or tissue-engineered) in combination with apically positioned flaps (APF) resulted in significantly less gain in KT width compared to that achieved with FGGs and APFs. Around dental implants, free gingival grafts were deemed more effective than soft tissue substitutes in enhancing keratinized mucosa width. Based on the available evidence, questions remain about the alternative use of soft tissue substitutes for conventional grafting procedures using free gingival grafts or connective tissue grafts around teeth and implants.

Current Global Trends in Prepectoral Breast Reconstruction.

Implant-based breast reconstruction (IBBR) is the most frequently performed procedure for breast reconstruction following mastectomy, which involves the surgical placement of breast implants. The approach to breast reconstruction can be divided into two main categories, namely prepectoral breast reconstruction (PPBR) and subpectoral breast reconstruction (SPBR), based on the implant plan and placement technique. In recent years, there has been a significant surge in the popularity of prepectoral implant-based breast reconstruction, where the implants are positioned above the chest muscle, as opposed to beneath it in the subpectoral approach. However, despite this growing preference, there is a lack of comprehensive data regarding the national trends in the utilization of this technique, thus necessitating further investigation. This narrative review aims to ascertain the current global patterns linked to prepectoral breast reconstruction and elucidate the considerations surrounding patient and implant selection, reconstructive techniques, the utilization of meshes in prepectoral reconstruction, the ensuing outcomes and complications, the ramifications of radiotherapy, and the potential advantages of integrating fat infiltration into the implementation of this technique in breast reconstruction with a focus on published papers in last five years. Conclusion: Prepectoral breast reconstruction has emerged as an appropriate surgical option for individuals seeking breast reconstruction. This development can be attributed to the recent progress made in implant technology, which has significantly enhanced the outcomes of this procedure. Additionally, advancements in mastectomy techniques, autologous fat grafting, and the use of acellular dermal matrices (ADMs) have also played a vital role in improving the aesthetic results of prepectoral breast reconstruction. As a result, the significance and effectiveness of this technique in the field of breast reconstruction have been firmly established, making it an essential component of the overall armamentarium available to plastic surgeons for breast reconstruction purposes.

Experimental Study on Transverse-Axis Neovascularization of Acellular Dermal Matrix Using Platelet-Rich Plasma

Background: Acellular dermal matrices (ADMs) have shown promise in promoting tissue regeneration; however, their integration in challenging cases with limited vertical-axis neovascularization remains difficult. This study investigates whether clinically meaningful transverse-axis neovascularization is identified in ADM engraftment and whether this can be further accelerated by platelet-rich plasma (PRP).Methods: ADM and PRP-soaked ADM were implanted into New Zealand rabbits, and histological analysis was performed at different periods to compare neovascularization.Results: Histological analysis revealed that among 32 biopsy sites, there was transverse-axis neovascularization with an average length of 606.89 μm. When divided into two groups for assessing the impact of PRP on transverse-axis neovascularization, the extent of such neovascularization was measured as 582.99 μm in the control group and 630.79 μm in the experimental group. However, there was no statistically significant difference between the two groups (P=0.693).Conclusion: The results of the present study indicate that achieving meaningful transverse-axis neovascularization in implanted ADMs remains a challenge, warranting further investigation into ADM structure and vertical-axis neovascularization.

The use of dermal templates in dermato-surgery and patient perspectives.

Acellular dermal matrices currently represent a useful reconstructive method in onco-dermatologic surgery. Nevertheless, they have some limitations, especially in terms of costs and outpatient post-operative wound care. While some studies on their cost-to-benefit ratio in breast surgery have already been issued, evidence is currently lacking in onco-dermatological surgery. The aim of this study was to evaluate the clinical outcomes perceived by patients who had undergone onco-dermatologic surgery in which either acellular dermal matrices or skin grafts had been used as reconstructive methods. A study population of 150 patients was identified retrospectively and patients' degree of satisfaction was assessed through the Global Aesthetic Improvement Scale and the Patient Scar Scale Questionnaire. Despite similar scores among the study groups, slightly better results were appreciable after single-stage grafting. However, to what extent these variations really represent a significant difference from a clinical point of view remains to be determined. Moreover, other potential bias in the interpretation of our results may reside in differences in terms of age, body location and baseline tumor size among the study groups. Therefore, further research is needed.

(224) The Use of an Acellular Dermal Matrix for Peyronie’s Plaque Excision and Grafting

Abstract Introduction The optimal surgical approach for severe Peyronie’s disease (PD) and the ideal grafting material are debatable. Acellular dermal matrices (ADM), among other graft materials that have been reported in the literature, are ideal candidates for graft choice due to the ability to retain structural integrity during the healing process and low immunoreactivity levels. Their use remains novel and only a few small studies have described outcomes of ADM grafting for PD. Objective The current study reports on the largest cohort of patients in the literature undergoing PEG with ADM (FlexHD Pliable). Methods After IRB approval, we reviewed the medical records of all patients undergoing PEG with Flex HD Pliable at our institution between the period of 2014 to 2023. A total of 52 patients with PD underwent PEG with FlexHD Pliable graft, with or without simultaneous inflatable penile prosthesis (IPP) insertion. Preoperative urological assessment of plaque was undertaken using penile color duplex ultrasound (PNUS) and degree of angulation and calcifications were recorded. All patients underwent surgery by a single surgeon. Results Patient’s age was 59.1+/-8.4 (43 to 81) years old. Dorsal curvature was recorded in 46.2% of patients, 23% had lateral, 13.5% had ventral and 17.3 % of patients had a combined curvature. Average penile curvature was 61+/-16 degrees (range 30-90 degrees). Hourglass deformity was recorded in 29.4% of cases; plaque calcification was confirmed on PNUS. The mean time between onset of curvature and surgical treatment was 25±37.9 months (range: 1-204 months). 19.2% patients failed intralesional treatment with Xiaflex prior to surgery and 4% had prior surgical treatment. In 75% of cases, simultaneous IPP placement was performed and in 25% of cases we performed PEG with FlexHD Pliable grafting only. Mean operative time for PEG was 114±22 minutes and simultaneous IPP placement prolonged the average operative time to 147±38 minutes. The average defect size was 21±8.3 cm2 (range: 4-48 cm2). A complete curvature correction was achieved in 90.4% and 9.6% had an average residual curvature of 11.25 °±4.8° (range: 5 ° -15 °). Eight patients (15.4%) reported postsurgical complications. Among them, two patients (3.8%) with altered penile sensation. One patient reported absence of sensation at the tip in the right mid glans; a decreased sensation at the ventral part of the penile shaft was recorded in the second case. There was one case of reactive hydrocele following IPP placement (2%) and five patients (9.6%) developed hematomas: 2 subcapsular graft hematomas required needle aspiration under PNUS guidance, a left spermatic cord hematoma and two penile hematomas that resolved spontaneously. Recurrent curvature onset was recorded in 4 patients (7.7%), but only 2 (3.8%) required re-operation. None of the patients suffered from infection-related complications. Conclusions Our results demonstrate the largest experience with ADM grafting for PD in the literature. PEG with FlexHD Pliable is a safe alternative to other commercially available grafting materials with a low complication rate. In the absence of a gold standard treatment for PD grafting materials, FlexHD Pliable is a practical and valuable option for this surgery. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Irrimax.

A Comparison of Ovine-Reinforced Hybrid Mesh (OviTex PRS) With Porcine Acellular Dermal Matrix (STRATTICE) in the Treatment of Advanced Breast Implant Capsular Contracture.

Tissue reinforcement techniques with porcine acellular dermal matrices (ADMs) have been widely adopted as standard care in treating capsular contracture. However, the application of alternative xenograft or mesh materials has not been widely studied. To examine the efficacy of OviTex PRS Reinforced Tissue Matrix (Resorbable) (TELA Bio, Malvern, PA), a hybrid ovine-reinforced mesh, in comparison with STRATTICE Reconstructive Tissue Matrix (Allergan, Irvine, CA), in patients with advanced capsular contracture. A retrospective review was conducted on patients who underwent breast revision surgery for Baker Grade III or IV capsular contracture. Patient data were reviewed for outcomes, complications, cost, and postoperative incidence of recurrent capsular contracture after treatment with each specific mesh. Fifty-nine of 89 breasts (66.3%) were treated with OviTex and 30 (33.7%) were treated with STRATTICE. All patients experienced a reduction in Baker grades. In patients treated with OviTex, 96.6% (n = 57) of breasts had a postoperative Baker Grade I with the remaining 3.4% (n = 2) breasts presenting with a Baker Grade II. In comparison, 73.3% (n = 22), 23.3% (n = 7), and 3.3% (n = 1) of the STRATTICE cohort presented with Baker Grades I, II, and III, respectively. This demonstrated a statistically significant improvement in Baker grade capsular contracture in the OviTex cohort (P < .05) compared with STRATTICE. Average cost was $27.37/cm2 for STRATTICE compared with $22.28/cm2 for OviTex PRS. OviTex may be successfully utilized to treat capsular contracture. Patient outcomes may be superior to STRATTICE in recurrent capsular contracture, particularly when a previous ADM had been utilized. Cost data show improved savings with the use of OviTex compared with STRATTICE.

Current status prepectoral and subpectoral breast reconstruction in the USA.

Breast cancer remains the most commonly diagnosed cancer in women in the United States. In the setting of a mastectomy, implant-based reconstruction (IBR) remains the most common type of breast reconstruction performed. IBR is typically performed in two-stages (tissue expander - implant) or one stage [direct-to-implant (DTI)]. As a consequence of the limitations associated with submuscular placement of implants, prepectoral implant placement has been gaining more acceptance worldwide. The prepectoral plane eliminates the need for chest wall muscle dissection, disinsertion and manipulation avoiding the muscle related complications of the subpectoral approach such as increased pain, spasm and animation deformity. In addition, prepectoral placement shortens the recovery time and provides greater control of breast shape and contour. With the latest generation form-stable silicone implants coupled with the wide use and acceptance of acellular dermal matrices (ADMs) and other meshes to support the implant, this technique is becoming the mainstay of implant-based reconstruction, under these circumstances the subpectoral technique will continue to be the benchmark to which the prepectoral technique will be compared to. The authors sought to review the literature emanating from North America that pertains to this topic and provide an up-to-date assessment of the current practices of the prepectoral and submuscular technique.

Human-Mimic Submuscular and Premuscular Irradiated Rat Model: Histologic Characteristics of the Capsule Tissue in Contact with the Breast Implant.

In this study, we established two rat models that mimic human submuscular and premuscular breast reconstruction. We analyzed the capsule formation according to surgical techniques and adjacent tissues, including the chest wall tissues, such as the ribs and acellular dermal matrices (ADMs) that come in contact with silicone implants. This study consisted of experiments on 12 Sprague-Dawley rats that underwent implant reconstruction using ADM. They were divided into two groups: rats that underwent dual-plane implantation (n = 6; group 1) and those that underwent premuscular implant insertion (n = 6; group 2). All rats were irradiated with 35 Gy of fractionated radiation. Three months after surgery, the histology and immunochemistry of the capsule tissues of the ADM, muscle, and chest wall were analyzed. Overall capsule thickness was thicker in group 1. Based on the tissue in contact with the silicone implant, ADM had a thinner capsule, less inflammation, less fibrosis, and less vascularization than the muscle and chest wall tissues. This study described two rat models of clinically relevant implant-based breast reconstruction using a submuscular and premuscular plane, ADM, and irradiation. Overall, the premuscular implantation rat model was associated with a thinner capsule. The ADM in contact with the silicone implant, even after irradiation, had superior protection from radiation compared with the other tissues.

Properties of three collagen scaffolds in comparison with native connective tissue: an in-vitro study

PurposeTo evaluate collagen scaffolds (CS) in terms of their in vitro resorption behavior, surface structure, swelling behavior, and mechanical properties in physiologically simulated environments, compared with porcine native connective tissue.Materials and methodsThree test materials—one porcine collagen matrix (p-CM), two acellular dermal matrices (porcine = p-ADM, allogenic = a-ADM)—and porcine native connective tissue (p-CTG) as a control material were examined for resorption in four solutions using a high-precision scale. The solutions were artificial saliva (AS) and simulated body fluid (SBF), both with and without collagenase (0.5 U/ml at 37 °C). In addition, the surface structures of CS were analyzed using a scanning electron microscope (SEM) before and after exposure to AS or SBF. The swelling behavior of CS was evaluated by measuring volume change and liquid absorption capacity in phosphate-buffered saline (PBS). Finally, the mechanical properties of CS and p-CTG were investigated using cyclic compression testing in PBS.ResultsSolutions containing collagenase demonstrated high resorption rates with significant differences (p < 0.04) between the tested materials after 4 h, 8 h and 24 h, ranging from 54.1 to 100% after 24 h. SEM images revealed cross-linked collagen structures in all untreated specimens. Unlike a-ADM, the scaffolds of p-CM and p-ADM displayed a flake-like structure. The swelling ratio and fluid absorption capacity per area ranged from 13.4 to 25.5% among the test materials and showed following pattern: p-CM > a-ADM > p-ADM. P-CM exhibited higher elastic properties than p-ADM, whereas a-ADM, like p-CTG, were barely compressible and lost structural integrity under increasing pressure.Conclusions and clinical implicationsCollagen scaffolds vary significantly in their physical properties, such as resorption and swelling behavior and elastic properties, depending on their microstructure and composition. When clinically applied, these differences should be taken into consideration to achieve the desired outcomes.Graphical

A prospective randomized clinical trial to assess antibiotic pocket irrigation on tissue expander breast reconstruction.

Bacterial infection is the most common complication following staged post-mastectomy breast reconstruction initiated with a tissue expander (TE). To limit bacterial infection, antibiotic irrigation of the surgical site is commonly performed despite little high-quality data to support this practice. We performed a prospective randomized control trial to compare the impact of saline irrigation alone to a triple antibiotic irrigation regimen (1 g cefazolin, 80 mg gentamicin, and 50,000 units of bacitracin in 500 mL of saline) for breast implant surgery. The microbiome in breasts with cancer (n = 16) was compared to those without (n = 16), as all patients (n = 16) had unilateral cancers but bilateral mastectomies (n = 32). Biologic and prosthetic specimens procured both at the time of mastectomy and during TE removal months later were analyzed for longitudinal comparison. Outcomes included clinical infection, bacterial abundance, and relative microbiome composition. No patient in either group suffered a reconstructive failure or developed an infection. Triple antibiotic irrigation administered at the time of immediate TE reconstruction did not reduce bacterial abundance or impact microbial diversity relative to saline irrigation at the time of planned exchange. Implanted prosthetic material adopted the microbial composition of the surrounding host tissue. In cancer-naïve breasts, relative to saline, antibiotic irrigation increased bacterial abundance on periprosthetic capsules (P = 0.03) and acellular dermal matrices (P = 0.04) and altered the microbiota on both. These data show that, relative to saline only, the use of triple antibiotic irrigation in TE breast reconstruction does impact the bacterial abundance and diversity of certain biomaterials from cancer-naïve breasts. IMPORTANCE The lifetime risk of breast cancer is ~13% in women and is treated with a mastectomy in ~50% of cases. The majority are reconstructed, usually starting with a tissue expander to help restore the volume for a subsequent permanent breast implant or the women's own tissues. The biopsychosocial benefits of breast reconstruction, though, can be tempered by a high complication rate of at least 7% but over 30% in some women. Bacterial infection is the most common complication, and can lead to treatment delays, patient physical and emotional distress and escalating health care cost. To limit this risk, plastic surgeons have tried a variety of strategies to limit bacterial infection including irrigating the pocket created after removing the breast implant with antibiotic solutions, but good-quality data are scarce. Herein, we study the value of antibiotics in pocket irrigation using a robust randomized clinical trial design and molecular microbiology approaches.

Acellular Dermal Matrices in Prepectoral Breast Reconstruction-Do We Need It?

Acellular Dermal Matrices in Prepectoral Breast Reconstruction-Do We Need It?

Incidence of capsular contracture on irradiated acellular dermal matrices (ADMs)-assisted prepectoral breast reconstructions

Tania Saibene, Claudia Cecconi, Maria Cristina Toffanin, Matteo Cagol, Massimo Ferrucci, Raffaello Grigoletto, Silvia Michieletto

Discussion: Do Corporate Payments Influence Research Related to the Use of Acellular Dermal Matrices in Breast Surgery?

Discussion: Do Corporate Payments Influence Research Related to the Use of Acellular Dermal Matrices in Breast Surgery?

Interest of acellular dermal matrices in immediate breast reconstruction: Comparison of quality of life and complications with and without matrix

Since 2001, acellular dermal matrices have been increasingly used in immediate breast reconstruction (IBR) because they allow for the placement of the ideal-sized definitive implant in one step. They are used in both retropectoral and prepectoral prosthetic breast reconstructions. The aim of this study was to evaluate the impact of dermal matrices on the quality of life and on complications. Two surveys were used to evaluate the quality of life: the BREAST-Q V2.0© and the QuickDASH. The surveys were sent to all patients who had an immediate prosthetic breast reconstruction at a University Hospital Center from 2010 to 2020. A case-control study was performed for comparison of responses between the "Matrix+" and "Matrix-" groups. Seventeen IBR with matrix (23.6%) and 55 IBR without matrix (76.4%) were analyzed. Patients in the "Matrix+" group had a better quality of life in terms of sexual well-being (p=0.038) and a significantly lower QuickDASH (p<0.01). They had better breast satisfaction (p=0.016) and better implant satisfaction (p<0.01). The likelihood of encountering major complications later in time was more important in the group with matrix (p=0.04). We found a satisfactory quality of life with scores of sexual well-being and satisfaction with the breast and the implants, and a better satisfaction with care thanks to the use of the matrices. However, due to a higher number of major late complications and a lack of follow-up, we believe that immediate prosthetic breast reconstruction with matrix should be discussed according to the comorbidities, medical treatments, and the vitality of the skin flaps of each patient.

Efficacy of Acellular Dermal Matrix Type in Treatment of Capsular Contracture in Breast Augmentation: A Systematic Review and Meta-Analysis.

Capsular contracture is a known complication of breast augmentation and is among the top reasons for revisional breast augmentation procedures. The use of acellular dermal matrix (ADM) has been shown to reduce the rate of capsular contracture in breast reconstruction and augmentation, theorizing that it acts as a protective barrier between the implant capsule and inflammatory process responsible for capsular contracture. The role of ADM in treatment of capsular contracture has been investigated in numerous studies, with a variety of ADMs. The aim of this study was to perform a systematic review of existing literature on the use of ADM for treatment of capsular contracture in aesthetic breast augmentation patients to investigate differences in efficacy of ADM types. The PubMed, Embase, and CINAHL databases were systematically reviewed for articles pertaining to capsular contracture, acellular dermal matrices, and breast augmentation. Number of patients, type of ADM, Baker grade, follow-up time, complication rate, and capsular contracture rate were recorded from identified articles. Data was pooled from studies to calculate a capsular contracture rate for each ADM type, with a chi-squared test performed for analysis. Identified studies with a comparative group were included in a meta-analysis utilizing risk ratio (RR) to assess the efficacy of ADM. Nine articles including ADM for treatment of capsular contracture in breast augmentation met criteria for inclusion, with a total of 481 breasts. Strattice was the most commonly utilized ADM (n = 391), followed by AlloDerm (n = 57). There was a statistically significant difference in efficacy of ADM among the studied ADM types (P < .001). AlloDerm, FlexHD, and DermaMatrix had the lowest capsular contracture rates (0%). NeoForm and SurgiMend had the highest capsular contracture rates (each 25%, but with n = 4 and n = 8, respectively). Strattice had a capsular contracture rate of 1.53% in the pooled data, and meta-analysis showed that Strattice reduced the risk of capsular contracture (RR 0.14 [95% CI 0.06, 0.31]) compared with conventional treatment. Acellular dermal matrices appear to be effective at treating capsular contracture after breast augmentation while maintaining a low complication rate. Overall capsular contracture rates are low with the use of ADM. There is a statistically significant difference in efficacy among ADM types. Meta-analysis shows that Strattice is effective at reducing the risk of capsular contracture in breast augmentation patients when compared to conventional treatment. Future research, especially in the form of randomized controlled trials, is needed to further investigate the efficacy of various ADMs in the treatment of capsular contracture.

Bovine Acellular Dermal Matrix-Based Breast Reconstruction in Previously Irradiated Breasts: Complications and Outcomes From a Single-Center Experience.

Radiation therapy is considered today an integral part of the management of breast cancer. However, radiotherapy significantly increases the incidence of total complications in breast reconstruction. Several procedures have been adopted to reduce complication rates in irradiated fields, including the use of acellular dermal matrices (ADMs). We conducted a retrospective analysis of our single-center experience with ADM-assisted implant-based reconstruction or revision surgeries for capsular contracture treatment in irradiated breasts. We divided our population into 4 groups based on prior surgical history: group A (previous quadrantectomy), group B (previous mastectomy and expander reconstruction), group C (previous mastectomy and implant reconstruction), and group D (prior quadrantectomy followed by mastectomy and implant reconstruction). At the European Oncology Institute in Milan, Italy, between June 2017 and April 2019, we identified 84 patients for a total of 86 irradiated breasts reconstructed with implant and ADM. We observed a total of 12 reconstructive failure, with the highest rate of failure in group B (16.6%) and in group D (15.38%). Overall, we recorded 22 total complications (24.4%): 12 major complications and 10 minor complications. The most common complication was infection, with 9 cases (10.4%), 6 of which were classified as severe and required implant removal. In group B, we observed the highest complication rate, both major and minor, with 7 of 42 patients (16.6%) experiencing each. Before reconstruction with ADM, the Baker grade ranged from 3 to 4, with a mean of 3.25. At the 2-year follow-up, the Baker grade ranged from 1 to 4, with a mean of 1.9. Surgeons were highly satisfied with the aesthetic result in 72.1% of cases, moderately in 8.1% and unsatisfied in 5.81%, and in 13.9%, the outcome was not assessable because of reconstructive failure. The worst aesthetic result was in group B. We observed significant reduction in capsular contracture in revision surgeries despite a moderately high rate of complications in previous quadrantectomy and radiotherapy. In our experience, breast reconstruction with implant and ADM is not the primary surgical indication in case of prior irradiation, but it can be considered as a valid alternative with reasonable safety profile, to be used in selected cases.

Safety and aesthetic outcomes of SERASYNTHⓇ MESH BR for direct-to-implant breast reconstruction: A retrospective single center analysis of 32 consecutive cases

BackgroundBilateral mastectomy for both therapeutic and prophylactic reasons is becoming increasingly important. To achieve good results after mastectomy, synthetic meshes are often used as an alternative to acellular dermal matrices (ADMs). The aim of this study is to analyze the results of subcutaneous mastectomies and direct-to-implant breast reconstruction using SERASYNTHⓇ MESH BR. MethodsIn this work, data from mastectomies (n = 32) in 22 patients without prior radiation after breast reconstruction with SERASYNTHⓇ MESH BR from a single center were retrospectively analyzed with 1 year follow-up. Complications were categorized as serious (need for revision surgery) and minor events. Statistical analysis was performed using the t-test in SPSS. Data were compared with the existing literature. ResultsMajor complications occurred in 15.6% (n = 5). Two out of five revisions were due to hematoma. In three cases, a seroma followed by other complications (e.g., infections, necrosis) necessitated revision. Minor complications occurred in 12.5% of cases. Due to the safety aspect, implants were replaced in each revision. There was no significant difference in complication rates between prophylactic and therapeutic mastectomies (p = 0.3815, SE = 0.171). There was no statistically significant difference in esthetic outcomes (p = 0.3846). ConclusionThe application of the absorbable polymer poly-p-dioxanone SERASYNTHⓇ MESH BR has complication rates comparable to those reported in the existing literature. Careful patient selection is paramount in order to limit the complication rate. SERASYNTHⓇ MESH BR can be considered a safe tool to achieve esthetic results in combination with direct-to-implant breast reconstruction.

A Two-Year Retrospective Analysis of the Clinical Outcomes of Immediate Submuscular Breast Reconstructions With Native® Acellular Dermal Matrix.

Implant-based submuscular breast reconstruction (SBR) can be performed with the aid of acellular dermal matrices (ADM) for implant coverage on their inferolateral pole, aiming at providing a biological interface for hiding the implant and therefore reducing the risk of complications. The purpose of this study is to assess the long-term post-operative outcomes obtained using the SBR-specific Native® ADM (DECO med s.r.l., Marcon, Venice, Italy). All cases of Native®-assisted immediate SBR performed at our institution between October 2016 and March 2020 were retrospectively analysed. Demographic and surgical data were collected, and post-operative outcomes, including minor and major complications, were evaluated. Particular attention was paid to complications emerging before and after patient discharge. Dependence analyses were performed to uncover statistically significant relationships between risk factors and reconstructive outcomes. Data on 100 patients were collected, for a total of 128 breasts. The mean age of the cohort was 49.5 years, the mean BMI was 23.4 kg/m2, and the mean follow-up was 24 months. Out of this, 14.1% of patients received pre-operative radiotherapy, while 16.4% underwent post-mastectomy radiotherapy. Breasts appeared to develop short-term minor complications more likely during hospitalisation (11.7% vs. 7.8%), while short-term major complications occurred more often after discharge (7.8% vs. 15.6%). The most frequent long-term complications were capsular contracture and contour defects (both 9.4%). Risk factors that showed a statistically significant relationship with complications were pre- and post-mastectomy radiotherapy and post-operative chemotherapy. The retrospective analysis showed results in line with clinical outcomes reported in the literature for the same reconstructive technique. The use of Native® ADM in SBR is safe and effective in the long term.

Difference in the outcomes of anterior tenting and wrapping techniques for acellular dermal matrix coverage in prepectoral breast reconstruction

Acellular dermal matrices (ADMs) play an essential role in prepectoral implant-based breast reconstructions; however, the most appropriate method for ADMs is unknown. We conducted a retrospective analysis of our institutional database. Patients who underwent mastectomy and prepectoral breast reconstruction using tissue expanders or breast implants covered with ADMs between March 2018 and June 2021 were included. Patient characteristics, postoperative complications, and long-term outcomes were investigated. In total, 112 patients (126 breasts) were included. The anterior tenting and wrapping techniques were used in the reconstruction of 32 (25.3%) and 94 (74.7%) breasts, respectively. Using propensity score matching, nine breasts were selected for each technique within the direct-to-implant reconstruction group, while 16 breasts were selected for each technique within the 2-stage reconstruction group. The choice of technique (anterior vs. wrapping) in implementing ADM did not generate any significant differences in postoperative complications, including seroma formation and capsular contracture, for the direct-to-implant and 2-stage reconstruction groups. Regarding the direct-to-implant reconstruction group, the average postoperative drain volume was less in the anterior tenting group than that in the wrapping group (anterior tenting vs. wrapping; 495.09±156.118mL vs. 673.43±307.954mL, p=0.006), but the difference was insignificant after propensity score matching. We report our experience with covering prosthetic devices with ADMs during postmastectomy breast reconstruction. No differences in the postoperative drain volume or postoperative outcomes were found between the study groups. Future studies are needed to determine the method that provides the most satisfactory results.