To acellular dermal matrix or not to acellular dermal matrix?-outcomes of pre-pectoral prosthetic reconstruction after nipple-sparing mastectomy with and without acellular dermal matrix

Elizabeth E Bushong ¹, Nicholas Wesely ², Ewa Komorowska-Timek ^2,3

⁰Michigan State University College of Human Medicine, Grand Rapids, MI, USA.

Gland Surgery +

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July 17, 2024

View abstract on PubMed

Summary

Acellular dermal matrix (ADM) in breast reconstruction did not improve outcomes and increased nipple necrosis. Direct-to-implant (DTI) reconstruction showed fewer complications than tissue expander (TE) reconstruction.

Area Of Science

Plastic Surgery
Biomaterials Science
Oncology

Background

Acellular dermal matrix (ADM) is commonly used in pre-pectoral breast reconstruction after mastectomy.
ADM is believed to reduce capsular contracture and improve soft tissue coverage.
However, ADM may increase complication rates, prompting an evaluation of its necessity.

Purpose Of The Study

To evaluate the necessity and impact of acellular dermal matrix (ADM) in pre-pectoral breast reconstruction.
To compare complication rates between breasts reconstructed with and without ADM.
To assess the influence of implant type (tissue expander vs. direct-to-implant) on outcomes.

Main Methods

Retrospective analysis of 115 immediate pre-pectoral breast reconstructions (66 patients) between April 2013 and January 2021.
Patients underwent nipple-sparing mastectomy (NSM) followed by tissue expander (TE) or direct-to-implant (DTI) reconstruction.
Cohorts were stratified based on the use of ADM, and early postoperative complications (within 30 days) were analyzed.

Main Results

Breasts reconstructed with ADM showed significantly higher rates of nipple necrosis (28.0% vs. 10.0%, P=0.02) compared to those without ADM.
Direct-to-implant (DTI) reconstruction was associated with lower rates of nipple necrosis (11.4% vs. 26.3%, P=0.04), implant loss (5.7% vs. 38.8%, P=0.004), and overall complications requiring surgery (14.3% vs. 27.5%, P=0.04) compared to TE.
Overall outcomes between ADM and no-ADM groups were similar, suggesting ADM may not be essential.

Conclusions

The use of acellular dermal matrix (ADM) in pre-pectoral breast reconstruction did not demonstrate improved outcomes and was associated with increased nipple necrosis.
Direct-to-implant (DTI) reconstruction appears to be a safer alternative with fewer early complications compared to tissue expander (TE) reconstruction in this cohort.
Potential confounding factors, such as the placement of TE in breasts with presumed poorer vascularity, may influence observed outcomes.

Keywords:

Acellular dermal matrix (ADM) breast reconstruction nipple-sparing mastectomy (NSM) pre-pectoral implant