Prepectoral Breast Reconstruction with Fenestrated Acellular Dermal Matrix: A Novel Design

Area of Science:

• Plastic Surgery
• Biomaterials
• Reconstructive Surgery

Background:

• Acellular dermal matrix (ADM) use has improved breast reconstruction outcomes.
• Fenestrated ADM offers technical advantages for implant coverage.
• Prepectoral reconstruction is gaining popularity for breast augmentation.

Purpose of the Study:

• To evaluate the safety and efficacy of a novel, surgeon-designed shaped fenestrated ADM in prepectoral breast reconstruction.
• To assess outcomes in direct-to-implant and 2-stage breast reconstruction using this ADM.
• To compare outcomes with traditional methods regarding complications, expansion, and patient satisfaction.

Main Methods:

• Retrospective review of 10 patients (18 breasts) undergoing prepectoral breast reconstruction with shaped fenestrated ADM (FlexHD Pliable).
• Reconstructions included direct-to-implant (88.9%) and 2-stage tissue expander (11.1%) approaches.
• Data collected on implant size, expander fill volume, complications, and patient-reported outcomes.

Main Results:

• No seroma or capsular contracture observed.
• Major complications requiring reoperation occurred in 22.2% of breasts (flap necrosis, infection).
• Patients experienced fewer postoperative expansions, faster time to full expansion, and reported less pain.

Conclusions:

• Prepectoral reconstruction with shaped fenestrated ADM is a safe and effective technique.
• This method facilitates direct-to-implant reconstructions and improves patient experience.
• Improved cosmetic outcomes, shape, and absence of animation deformity are key benefits.