Use Of Acellular Dermal Matrices Research Articles

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.

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.

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?

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.

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 revision breast augmentation procedures. The use of acellular dermal matrices (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, using a variety of ADM. 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 between ADM types. 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 Chi-squared test performed for analysis. Identified studies with a comparative group were included in meta-analysis utilizing risk ratio (RR) to assess efficacy of ADM. Nine articles using ADM for treatment of capsular contracture in breast augmentation met criteria for inclusion with a total of 481 breasts. Strattice (Lifecell Corporation, Branchburg, NJ) was the most commonly used ADM (n=391), followed by AlloDerm (n=57; Lifecell Corporation). There was a statistically significant difference in efficacy of ADM among the studied ADM types (p < 0.001). AlloDerm, FlexHD (MTF Biologics, Edison, NJ), and DermaMatrix have the lowest capsular contracture rates (0%). NeoForm (Mentor Corporation, Irving, TX) and SurgiMend (Integra LifeSciences, Princeton, NJ) have the highest capsular contracture rates (each 25%, but with n=4 and n=8, respectively). Strattice has a capsular contracture rate of 1.53% in the pooled data, and meta-analysis showed that Strattice reduces the risk of capsular contracture (RR 0.14 [95% CI 0.06, 0.31]) compared to 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 type. Meta-analysis shows that Strattice is effective at reducing the risk of capsular contracture in breast augmentation patients compared to conventional treatment. Future research, especially in the form of randomized-controlled trials, is needed to further investigate the efficacy of various ADM in the treatment of capsular contracture.

D82. Acellular Dermal Matrix-assisted, Implant-based Breast Reconstruction: A Comparison of SurgiMend, AlloDERM, and DermACELL

PURPOSE: Acellular dermal matrices (ADMs) are frequently employed during implant-based breast reconstruction (IBBR) to provide structural support and optimize outcomes. ADMs differ in derivative (fetal bovine, porcine, human), cost and processing; yet few studies directly compare their outcomes. We sought to compare outcomes across three ADMs: SurgiMend (bovine-derived), AlloDerm (human-derived), and DermACELL (human-derived). METHODS: A multicenter retrospective review of patients receiving IBBR with SurgiMend, AlloDerm, or DermACELL between January 2014 and July 2022 was performed. Primary outcomes included explantation or total reconstructive failure. Secondary outcomes included 90-day postoperative complications and rates of capsular contracture within a two-year follow-up. RESULTS: A total of 439 patients receiving IBBR using ADM were identified. Of those, 215 patients (367 breasts) had full chart reviews. Mastectomy type preceding ADM use differed significantly (p=0.034), though nipple-sparing mastectomy was the most common for all cohorts. While most patients received direct-to-implant reconstruction, significant differences existed between ADM (p<0.0001). Short-term complications, total reconstruction failure, and reoperation within 90-days were comparable. No differences were found for rates of capsular contracture (p=0.385) and explantation (p=0.694). CONCLUSION: This preliminary data demonstrates equivalence in short- and long-term complications between SurgiMend, AlloDerm, and DermACELL. Our findings support further evidence-based use of ADMs.

National Trends in Acellular Dermal Matrix Utilization in Immediate Breast Reconstruction.

Implant-based reconstruction is the most common method of immediate breast reconstruction in the United States, with acellular dermal matrices (ADMs) playing a significant role in implant support and coverage. This study evaluated recent national trends in ADM use in immediate breast reconstruction and assessed patient characteristics and 30-day complication rates. The authors queried the American College of Surgeons National Surgical Quality Improvement Program database for all patients undergoing immediate breast reconstruction from 2015 to 2020. Primary outcomes were major surgical and medical complications, as well as ADM use per year. Subset analysis was performed to compare patients undergoing immediate breast reconstruction with ADM in 2015 versus 2020. In 39,800 immediate breast reconstructions, ADMs were used in 55.5% of cases ( n = 22,087). ADM usage increased annually from 2015 through 2020. Direct-to-implant reconstruction was significantly associated with ADM use ( P < 0.001). Compared with the no-ADM cohort, there was a significantly increased rate of return to the operating room for any reason ( P < 0.001). When comparing the 2015 and 2020 ADM cohorts, the 2020 ADM cohort had a significantly higher rate of superficial infections. Obesity, smoking history, and insulin-dependent diabetes were independent risk factors for superficial wounds in patients receiving ADM. ADM use in immediate breast reconstruction increased significantly from 2015 to 2020, likely reflecting national trends in increasing direct-to-implant and prepectoral breast reconstruction. Obesity, smoking history, and insulin-dependent diabetes were independent risk factors for superficial wound infections in the ADM cohort. Patients with ADM had a slight increased incidence of return to the operating room. Risk, II.

Difference in the occurrence of capsular contracture according to the characteristics of the tissue in an irradiated rat model.

In this study, it was hypothesized that the capsule formation varies according to the radiation dose in the muscle tissues; chest wall tissues, including the ribs; and acellular dermal matrices (ADM) that are in contact with the silicone implant. This study consisted of 20 SD rats that underwent submuscular plane implant reconstruction using ADM. They were divided into four groups: Group 1 as the un-radiated control (n = 5), Group 2 with non-fractionated radiation at a dose of 10 Gy (n = 5), Group 3 with non-fractionated radiation at a dose of 20 Gy (n = 5), and Group 4 with fractionated radiation at a dose of 35 Gy (n = 5). Three months after surgery, hardness was measured. Moreover, the histology and immunochemistry of the capsule tissues of the ADM, muscle tissues, and chest wall tissues were analyzed. As the radiation dose increased, the silicone implant became harder. But no significant difference in capsule thickness according to the radiation dose was observed. Based on the tissue in contact with the silicone implant, ADM has a thinner capsule thickness than the muscle tissues and less inflammation as well as less neovascularization compared with the other tissues. This study described a new rat model of clinically relevant implant-based breast reconstruction using a submuscular plane and ADM with irradiation. Therefore, it was confirmed that the ADM in contact with the silicone implant, even after irradiation, was protected from radiation compared with the other tissues.

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

No study has assessed the impact of financial conflicts of interests (COIs) on the reporting of breast reconstruction outcomes with acellular dermal matrix (ADM) in peer-reviewed publications. The authors hypothesized that there is (1) an association between financial COIs and likelihood of studies reporting benefits in using ADM, and (2) inconsistent reporting of financial COIs. The PubMed database was used to identify articles that reported on the use of ADM in breast surgery in four leading plastic surgery journals from January of 2014 to December of 2019. Financial COIs for authors were determined using the open payments database. Fifty-five articles were included. Twenty-four articles (43.6%) supported use of ADM, 12 (21.8%) did not promote ADM use, and 19 (34.5%) were neutral. Fifty-one studies (92.7%) had either a first or senior author with a COI, and authors with a COI more commonly reported positive outcomes ( P = 0.02). Studies with positive outcomes featured first authors who received significantly larger financial payments ($95,955 versus $15,642; P = 0.029) compared with studies with negative or neutral outcomes. Receiver operating characteristic curve demonstrated that studies with first authors receiving over $376.28 were more likely to report positive results. Eight senior authors and three first authors received greater than $500 from ADM producers yet did not report any financial disclosure. Financial COI is associated with higher likelihood of studies reporting benefit of using ADM in breast surgery. There remains inconsistent reporting of COIs, and better oversight is needed to ensure unbiased publication on the use of ADM in breast surgery.

Should Acellular Dermal Matrices Be Used for Implant-based Breast Reconstruction after Mastectomy? Clinical Recommendation Based on the GRADE Approach.

A panel of world-renowned breast specialists was convened to evaluate evidence, express personal viewpoints, and establish recommendation for the use of ADMs for subpectoral one-/two-stage IBBR (compared with no ADM use) for adult women undergoing mastectomy for breast cancer treatment or risk reduction using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Based on the voting outcome, the following recommendation emerged as a consensus statement: the panel members suggest subpectoral one- or two-stage IBBR either with ADMs or without ADMs for adult women undergoing mastectomy for breast cancer treatment or risk reduction (with very low certainty of evidence). The systematic review has revealed a very low certainty of evidence for most of the important outcomes in ADM-assisted IBBR and the absence of standard tools for evaluating clinical outcomes. Forty-five percent of panel members expressed a conditional recommendation either in favor of or against the use of ADMs in subpectoral one- or two-stages IBBR for adult women undergoing mastectomy for breast cancer treatment or risk reduction. Future subgroup analyses could help identify relevant clinical and pathological factors to select patients for whom one technique could be preferable to another.

Trends and Early Complications in Direct-to-Implant Breast Reconstruction: An Updated Analysis of the ACS-NSQIP Database

Background: Rates of direct-to-implant (DTI) breast reconstruction, in which breast implants are placed at the time of mastectomy, have been consistently rising. Advances in surgical adjuncts and technology, such as acellular dermal matrices (ADM), have made DTI reconstruction safer and more reliable. However, few studies have characterized early (30-day) postoperative complications following DTI. The aim of this study was to obtain a current understanding of early postoperative outcomes following DTI breast reconstruction. Methods: Using data from the American College of Surgeons-National Surgical Quality Improvement Program, we analyzed complications for female patients who underwent DTI reconstruction from 2017 to 2019, as well as trends in DTI reconstruction from data on mastectomy and DTI reconstruction from 2010 to 2019. We grouped complications into major surgical (including return to the operating room) or medical complications. Statistical analysis was performed using Fischer's exact test for categorical variables, Student's t-test for continuous variables, and logistic regression. Results: DTI breast reconstruction rates have increased since 2010. Among our 2017-2019 cohort of 4204 patients, the early major surgical complication rate was approximately 10% (422 patients) and the major medical complication rate was 0.83% (35 patients). Regression modeling identified body mass index, smoking status, hypertension, bleeding disorders, and intraoperative blood transfusion as having a relationship with surgical complications ( P &lt; .001). Conclusions: Despite increased use of ADM and indocyanine green angiography, compared to prior studies, early postoperative complications have remained stable. Further studies are needed to assess long-term complications and patient-reported outcomes in DTI breast reconstruction.

Postsurgical Outcomes with Meshes for Two-stage Prosthetic Breast Reconstruction in 20,817 Patients.

Patients who underwent breast reconstruction with and without ADM were identified from the National Surgical Quality Improvement Program database utilizing CPT codes. Covariates included patient demographics, preoperative comorbidities, and operative characteristics, while outcomes of interest were postoperative infection and reoperation. Univariate and multivariate analyses were performed to identify predictors of adverse outcomes. There were 8334 patients in the ADM cohort and 12,451 patients who underwent tissue expander breast reconstruction without ADM. There were significantly fewer reoperations in the non-ADM cohort (5.4%) compared to the ADM cohort (7.7%) (P < 0.0001), with infection and hematoma as the most common etiologies in both cohorts. Surgical infections were also more prevalent in the ADM cohort (4.7%) compared with the non-ADM cohort (3.6%) (P < 0.0001). Univariate and multivariate analysis of the tissue expander breast reconstruction cohort revealed race, obesity, hypertension, smoking status, albumin, and operative time as predictive for infection risk, while race, obesity, hypertension, smoking, albumin, operative time, and age were significant for reoperation. Our study of 20,817 patients revealed significantly higher risk of infection and reoperation in patients who underwent breast reconstruction utilizing ADM versus without ADM. Patients considering ADM for breast reconstruction should engage in discussion with their surgeon about complications, aesthetics, and cost.

Immediate Breast Cancer Reconstruction with or without Dermal Matrix or Synthetic Mesh Support: A Review and Network Meta-Analysis.

The use of acellular dermal matrices (ADMs) and synthetic mesh as part of implant-based breast reconstruction (IBBR) has been widely adopted. The authors investigated the clinical efficacy and safety of human ADM (HADM), xenograft ADM (XADM), and synthetic mesh as part of IBBR in postmastectomy patients as compared with previous standard implant reconstruction techniques using only a submuscular pocket for coverage. A systematic search for randomized controlled trials and observational studies was performed. A frequentist network meta-analysis was conducted using the R packages netmeta and Shiny. Thirty-one of 2375 studies identified met the predefined inclusion criteria. Traditional submuscular placement (no ADM or mesh) had fewer overall complications compared with HADM [OR, 0.51; credible interval (CrI), 0.34 to 0.74], but there was no significant difference between no ADM or mesh and XADM (OR, 0.63; CrI, 0.29 to 1.32) or synthetic mesh (OR, 0.77; CrI, 0.44 to 1.30). No one treatment was superior with regards to implant loss. No ADM or mesh was associated with fewer infectious complications than HADM (OR, 0.6; CrI, 0.39 to 0.89). Both no ADM or mesh (OR, 0.45; CrI, 0.27 to 0.75) and XADM (OR, 0.46; CrI, 0.23 to 0.88) had reduced seroma compared with HADM. Selecting the appropriate IBBR should evaluate effectiveness, adverse events, and cost. Although it is difficult to select a universal ideal IBBR, evaluation using this network analysis may help guide both physicians and patients in their choice of procedure, especially in the case of HADM, which in this study was shown to be significantly predisposed to complications of infection and seroma. Randomized data are required comparing XADM versus synthetic meshes, given the similar risk profiles but significant cost discrepancy between the techniques.

Braxon®-assisted prepectoral breast reconstruction: A decade later.

We are sitting on the cusp of the bioengineered breast era, in which implant-based breast reconstruction is seeing a growing trend and biotechnology research progressively empowers clinical practice. As never before, the choice of biomaterials has acquired great importance for achieving reconstructive outcomes, and the increase in the use of acellular dermal matrices (ADMs) in the field of senology tells us a story of profound upheaval and progress. With the advent of prepectoral breast reconstruction (PPBR), plenty of devices have been proposed to wrap the silicone prosthesis, either completely or partially. However, this has caused a great deal of confusion and dissent with regard to the adoption of feasible reconstructive strategies as well as the original scientific rationale underlying the prepectoral approach. Braxon® is the very first device that made prepectoral implant positioning possible, wrapping around the prosthesis and exerting the proven ADM regenerative potential at the implant-tissue interface, taking advantage of the body's physiological healing mechanisms. To date, the Braxon® method is among the most studied and practiced worldwide, and more than 50 publications confirm the superior performance of the device in the most varied clinical scenarios. However, a comprehensive record of the working of this pioneering device is still missing. Therefore, our aim with this review is to lay a structured knowledge of surgery with BRAXON® and to provide a decision-making tool in the field of PPBR through a complete understanding on the very first device for prepectoral, one decade after its introduction.

Postsurgical Outcomes with Acellular Dermal Matrices for Two-stage Prosthetic Breast Reconstruction in 20,817 Patients

PURPOSE: The use of acellular dermal matrices (ADM) for tissue expander breast reconstruction remains controversial with uncertain safety and efficacy profile. This study analyzes the rates and factors for reoperation and postoperative infection in patients who underwent tissue expander breast reconstruction with and without ADM. Methods Patients who underwent breast reconstruction with and without ADM were identified from the NSQIP database utilizing CPT codes. Covariates included patient demographics, preoperative comorbidities, and operative characteristics, while outcomes of interest were postoperative infection and reoperation. A univariate and multivariate analysis were performed to identify predictors of adverse outcomes. RESULTS: There were 8,334 patients in the ADM cohort and 12,451 patients who underwent tissue expander breast reconstruction without ADM. There were significantly fewer reoperations in the non-ADM cohort (5.4%) compared to the ADM cohort (7.7%) (p<0.0001), with infection and hematoma as the most common etiologies in both cohorts. Surgical infections were also more prevalent in the ADM cohort (4.7%) compared to the non-ADM cohort (3.6%) (p<0.0001). Univariate and multivariate analysis of the tissue expander breast reconstruction cohort revealed race, obesity, hypertension, smoking status, albumin, and operative time as predictive for infection risk, while race, obesity, hypertension, smoking, albumin, operative time, and age were significant for reoperation. CONCLUSION: Our study of 20,817 patients revealed significantly higher risk of infection and reoperation in patients who underwent breast reconstruction utilizing ADM compared to those without ADM. Patients considering ADM for breast reconstruction should engage in discussion with their provider about complications, aesthetics, and cost.

Absolute Incidence of Major and Minor Complications with Pre-Pectoral Breast Reconstruction with Postmastectomy Radiation

<h3>Purpose/Objective(s)</h3> Each year in the US approximately 250,000 women will be diagnosed with invasive breast cancer, and a little over one third will have regional disease (CDC 2020). Many of these women will undergo mastectomy and PMRT and will have to decide on reconstruction. Pre-pectoral implant reconstruction is becoming a more common option with the use of acellular dermal matrices. Jagsi et al (JNCI 2018) reported a 2-year implant-based complication rate of 38.9% with PMRT, however there is a paucity of data on the complication rate specifically for pre-pectoral implant reconstruction with PMRT. We looked to better understand the rate of complication with pre-pectoral complication with PMRT and breast reconstruction as well as provide thorough description of our patient demographics. <h3>Materials/Methods</h3> We retrospectively reviewed all female patients at our institution from 2015-2020 who underwent mastectomy with PMRT, and pre-pectoral implant reconstruction for invasive breast cancer, including: direct to implant, delayed implant, and tissue expander. Our primary outcome was the incidence of reconstruction related complications both minor and major at mean follow up of 2 years. <h3>Results</h3> We identified 34 women who met criteria for our study during this time period. With a mean follow up of 711 days, 20 of 34 women developed a complication for an absolute incidence of 58.8%. 10 were minor complications and 10 were major complications for an absolute incidence of 29.4% for each. Mean time to complication was 305 days. <h3>Conclusion</h3> Our most common reconstruction related complications were capsular contractions (13), however 9 of these were minor complications. This study supports that pre-pectoral reconstruction remains a valid option for women undergoing reconstruction and PMRT, and our results can be used to help counsel them on their rate of complications.

A successful closure of an extensive wound defect on the plantar surface in a patient with diabetes mellitus type 1 with combined application of bioplastic materials

A clinical case of successful surgical treatment of extensive purulent-necrotic lesion of the foot and lower leg in a comorbid patient is described in the article. The lesion had a neuroischemic form of the diabetic foot syndrome. The authors demonstrate the effectiveness of modern techniques for closing extensive soft tissue defects by the combined use of acellular dermal matrices based on collagen and chitosan in the treatment of complex postoperative wounds.

QS9. Do Corporate Payments Influence Research Related to the Use of Acellular Dermal Matrices in Breast Surgery?

QS9. Do Corporate Payments Influence Research Related to the Use of Acellular Dermal Matrices in Breast Surgery?

Implant-based Breast Reconstruction after Mastectomy for Breast Cancer: A Systematic Review and Meta-analysis.

Background:Women undergoing implant-based reconstruction (IBR) after mastectomy for breast cancer have numerous options, including timing of IBR relative to radiation and chemotherapy, implant materials, anatomic planes, and use of human acellular dermal matrices. We conducted a systematic review to evaluate these options.Methods:We searched Medline, Embase, Cochrane CENTRAL, CINAHL, and ClinicalTrials.gov for studies, from inception to March 23, 2021, without language restriction. We assessed risk of bias and strength of evidence (SoE) using standard methods.Results:We screened 15,936 citations. Thirty-six mostly high or moderate risk of bias studies (48,419 patients) met criteria. Timing of IBR before or after radiation may result in comparable physical, psychosocial, and sexual well-being, and satisfaction with breasts (all low SoE), and probably comparable risks of implant failure/loss or explantation (moderate SoE). No studies addressed timing relative to chemotherapy. Silicone and saline implants may result in clinically comparable satisfaction with breasts (low SoE). Whether the implant is in the prepectoral or total submuscular plane may not impact risk of infections (low SoE). Acellular dermal matrix use probably increases the risk of implant failure/loss or need for explant surgery (moderate SoE) and may increase the risk of infections (low SoE). Risks of seroma and unplanned repeat surgeries for revision are probably comparable (moderate SoE), and risk of necrosis may be comparable with or without human acellular dermal matrices (low SoE).Conclusions:Evidence regarding IBR options is mostly of low SoE. New high-quality research is needed, especially for timing, implant materials, and anatomic planes of implant placement.

335 Mesenchymal stem cells and acellular dermal matrices in wound healing: in vitro study of a combination treatment

Mesenchymal stem cells (MSCs) and acellular dermal matrices (ADMs) represent innovative and effective strategies in the setting of wound healing. The aim of our study was to assess the efficacy of a combination therapy based on the use of both MSCs and ADMs in vitro. Adipose-derived MSCs (ADSC) were plated on 8-mm punch-biopsies of a commercially available ADM (Integra®) and maintained in culture for 3 weeks. Then, conventional histology with hematoxylin-eosin staining, environmental scanning electron microscopy and confocal-laser scanning microscopy were used to obtain imaging of ADSC-seeded ADMs. Collagen autofluorescence was used to quantify collagen production by mean fluorescence intensity (MFI), expressed in terms of positive pixels/field, obtained through ImageJ software processing of threedimensional projections from confocal scanning images. ADSCs were efficiently seeded on Integra® and were perfectly incorporated in the pores of the scaffold. ADSCs were also demonstrated to actively proliferate in ADMs. Even more importantly, collagen autofluorescence was efficiently used as a surrogate marker of ECM production. In fact, based on MFI measurements, collagen production turned out to be significantly higher when ADSCs were seeded on ADM rather than in control conditions. In conclusion, our work supports the use of combined therapies based on MSCs and collagenic ADMs. In fact, not only ADSCs can be efficiently seeded on ADMs, but ADMs also seem to enhance their regenerative properties therefore making it a promising therapeutic option for chronic wounds.