Archives of Plastic Surgery

  • 제49권2호
  • /
  • Pages.166-173
  • /
  • 2022
  • /
  • 2234-6163(pISSN)
  • /
  • 2234-6171(eISSN)
대한성형외과학회 (Korean Society of Plastic and Reconstructive Surgeons)
권호 표지
DOI QR코드

DOI QR Code

Meshed Acellular Dermal Matrix for Two-Staged Prepectoral Breast Reconstruction: An Institutional Experience

  • Luo, Jessica (Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah) ;
  • Willis, Rhett N. Jr (Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah) ;
  • Ohlsen, Suzanna M. (Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah) ;
  • Piccinin, Meghan (Michigan State University College of Osteopathic Medicine) ;
  • Moores, Neal (Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah) ;
  • Kwok, Alvin C. (Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah) ;
  • Agarwal, Jayant P. (Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah)
  • 발행 : 2022.03.15
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

The introduction of acellular dermal matrix (ADM) to breast reconstruction has allowed surgeons to reexplore the prepectoral implant placement technique in postmastectomy breast reconstruction. Our institution adopted a novel approach using meshed ADM to lessen the financial burden of increased ADM utilization with the prepectoral breast reconstruction. This is a retrospective, single-center review of two-stage prepectoral breast reconstruction using meshed human-derived ADM for anterior prosthesis coverage. Patient demographics, oncologic data, perioperative characteristics, and complications were examined and reported as means with standard deviations. Cost-saving with the meshed technique was evaluated. Forty-eight patients (72 breasts) with a mean age of 48.5 ± 15.0 years (range 26-70 years) were included in the study. The mean follow-up time was 13.2 ± 4.4 months (range 4.1-25.8 months). Nineteen breasts (24.6%) experienced complications, with seromas being the most common complication (12.5%, n = 9). Expander removal and reoperation occurred at a rate of 8.3 and 9.7%, respectively. The average time to drain removal was 18.8 ± 6.6 days (range 8-32 days). Meshed ADM provided an average cost savings of $6,601 for unilateral and $13,202 for bilateral reconstructions. Our study found that human-derived meshed ADM can be safely used in two-staged prepectoral tissue expander-based breast reconstruction and can result in significant cost savings.

키워드

참고문헌

  1. Bloom JA, Patel K, Cohen S, et al. Prepectoral breast reconstruction: an overview of the history, technique, and reported complications. Open Access Surg 2020;13:1-9 https://doi.org/10.2147/oas.s201298
  2. Zenn MR. Indications and controversies for implant-based breast reconstruction utilizing biological meshes. Clin Plast Surg 2018;45(01):55-63 https://doi.org/10.1016/j.cps.2017.08.004
  3. Sigalove S. Options in acellular dermal matrix-device assembly. Plast Reconstr Surg 2017;140(6S Prepectoral Breast Reconstruction):39S-42S https://doi.org/10.1097/PRS.0000000000004049
  4. Hagarty SE, Yen LL, Luo J, Fosco CR, Gomez K, Khare M. Decreased length of postoperative drain use, parenteral opioids, length of stay, and complication rates in patients receiving meshed versus unmeshed acellular dermal matrix in 194 submuscular tissue expander-based breast reconstructions: a single-surgeon cohort study. Plast Reconstr Surg 2020;145(04):889-897 https://doi.org/10.1097/prs.0000000000006635
  5. Uzunismail A, Duman A, Perk C, et al. The effects of acellular dermal allograft (AlloDerm®) interface on silicone-related capsule formation-experimental study. Eur J Plast Surg 2008;31:179-185 https://doi.org/10.1007/s00238-008-0222-6
  6. Salzberg CA, Ashikari AY, Berry C, Hunsicker LM. Acellular dermal matrix-assisted direct-to-implant breast reconstruction and capsular contracture: a 13-year experience. Plast Reconstr Surg 2016;138(02):329-337 https://doi.org/10.1097/PRS.0000000000002331
  7. Sigalove S, Maxwell GP, Sigalove NM, et al. Prepectoral implant-based breast reconstruction: rationale, indications, and preliminary results. Plast Reconstr Surg 2017;139(02):287-294 https://doi.org/10.1097/PRS.0000000000002950
  8. Zammit D, Kanevsky J, Meng FY, et al. Meshed acellular dermal matrix: technique and application in implant based breast reconstruction. Plast Aesthet Res 2016;3:254-256 https://doi.org/10.20517/2347-9264.2015.128
  9. Ibrahim AM, Koolen PG, Ashraf AA, et al. Acellular dermal matrix in reconstructive breast surgery: survey of current practice among plastic surgeons. Plast Reconstr Surg Glob Open 2015;3(04):e381 https://doi.org/10.1097/GOX.0000000000000148
  10. Kim SE. Prepectoral breast reconstruction. Yeungnam Univ J Med 2019;36(03):201-207 https://doi.org/10.12701/yujm.2019.00283
  11. Lotan AM, Ben Yehuda D, Allweis TM, Scheflan M. Comparative study of meshed and nonmeshed acellular dermal matrix in immediate breast reconstruction. Plast Reconstr Surg 2019;144(05):1045-1053 https://doi.org/10.1097/PRS.0000000000006116
  12. Paprottka FJ, Krezdorn N, Sorg H, et al. Evaluation of complication rates after breast surgery using acellular dermal matrix: median follow-up of three years. Plast Surg Int 2017;2017:1283735 https://doi.org/10.1155/2017/1283735
  13. Gravina PR, Pettit RW, Davis MJ, Winocour SJ, Selber JC. Evidence for the use of acellular dermal matrix in implant-based breast reconstruction. Semin Plast Surg 2019;33(04):229-235 https://doi.org/10.1055/s-0039-1696986
  14. Hallberg H, Rafnsdottir S, Selvaggi G, et al. Benefits and risks with acellular dermal matrix (ADM) and mesh support in immediate breast reconstruction: a systematic review and meta-analysis. J Plast Surg Hand Surg 2018;52(03):130-147 https://doi.org/10.1080/2000656X.2017.1419141
  15. Nealon KP,Weitzman RE, Sobti N, et al. Prepectoral direct-to-implant breast reconstruction: safety outcome endpoints and delineation of risk factors. Plast Reconstr Surg 2020;145(05):898e-908e https://doi.org/10.1097/PRS.0000000000006721
  16. Baker BG, Irri R, MacCallum V, Chattopadhyay R, Murphy J, Harvey JR. A prospective comparison of short-term outcomes of subpectoral and prepectoral Strattice-based immediate breast reconstruction. Plast Reconstr Surg 2018;141(05):1077-1084 https://doi.org/10.1097/PRS.0000000000004270
  17. Wormer BA, Valmadrid AC, Ganesh Kumar N, et al. Reducing expansion visits in immediate implant-based breast reconstruction: a comparative study of prepectoral and subpectoral expander placement. Plast Reconstr Surg 2019;144(02):276-286 https://doi.org/10.1097/prs.0000000000005791
  18. Jafferbhoy S, Chandarana M, Houlihan M, et al. Early multicentre experience of pre-pectoral implant based immediate breast reconstruction using Braxon®. Gland Surg 2017;6(06):682-688 https://doi.org/10.21037/gs.2017.07.07
  19. Lee JS, Kim JS, Lee JH, et al. Prepectoral breast reconstruction with complete implant coverage using double-crossed acellular dermal matrixs. Gland Surg 2019;8(06):748-757 https://doi.org/10.21037/gs.2019.12.10
  20. Heidemann LN, Gunnarsson GL, Salzberg CA, Sorensen JA, Thomsen JB. Complications following nipple-sparing mastectomy and immediate acellular dermal matrix implant-based breast reconstruction: a systematic review and meta-analysis. Plast Reconstr Surg Glob Open 2018;6(01):e1625 https://doi.org/10.1097/GOX.0000000000001625
  21. Martin JB, Moore R, Paydar KZ, Wirth GA. Use of fenestrations in acellular dermal allograft in two-stage tissue expander/implant breast reconstruction. Plast Reconstr Surg 2014;134(05):901-904 https://doi.org/10.1097/PRS.0000000000000598
  22. Palaia DA, Arthur KS, Cahan AC, Rosenberg MH. Incidence of seromas and infections using fenestrated versus nonfenestrated acellular dermal matrix in breast reconstructions. Plast Reconstr Surg Glob Open 2015;3(11):e569 https://doi.org/10.1097/GOX.0000000000000559
  23. Wirth GA, Mowlds DS, Guidotti P, et al. Acellular dermal matrix fenestrations and their effect on breast shape. Eur J Plast Surg 2015;38:267-272 https://doi.org/10.1007/s00238-015-1090-5
  24. Cottler PS, Olenczak JB, Ning B, et al. Fenestration improves acellular dermal matrix biointegration: an investigation of revascularization with photoacoustic microscopy. Plast Reconstr Surg 2019;143(04):971-981 https://doi.org/10.1097/PRS.0000000000005410
  25. Hoppe IC, Yueh JH, Wei CH, Ahuja NK, Patel PP, Datiashvili RO. Complications following expander/implant breast reconstruction utilizing acellular dermal matrix: a systematic review and meta-analysis. Eplasty 2011;11:e40
  26. Lee KT, Mun GH. Updated evidence of acellular dermal matrix use for implant-based breast reconstruction: a meta-analysis. Ann Surg Oncol 2016;23(02):600-610 https://doi.org/10.1245/s10434-015-4873-9
  27. Kim JYS, Mlodinow AS. What's new in acellular dermal matrix and soft-tissue support for prosthetic breast reconstruction. Plast Reconstr Surg 2017;140(5S Advances in Breast Reconstruction):30S-43S https://doi.org/10.1097/PRS.0000000000003950
  28. Bank J, Phillips NA, Park JE, Song DH. Economic analysis and review of the literature on implant-based breast reconstruction with and without the use of the acellular dermal matrix. Aesthetic Plast Surg 2013;37(06):1194-1201 https://doi.org/10.1007/s00266-013-0213-2
  29. Nahabedian MY. Acellular dermal matrices in primary breast reconstruction: principles, concepts, and indications. Plast Reconstr Surg 2012;130(5, Suppl 2):44S-53S https://doi.org/10.1097/PRS.0b013e31825f2215
  30. Nahabedian MY. Prosthetic breast reconstruction with acellular dermal matrices: achieving predictability and reproducibility. Plast Reconstr Surg Glob Open 2016;4(05):e698 https://doi.org/10.1097/gox.0000000000000459