Serially Stacked Acellular Dermal Matrices in 2-Stage Implant-Based Breast Reconstruction

Acellular dermal matrix (ADM) is widely used in implant-based breast reconstruction for implant stabilization, soft-tissue augmentation, and reduced capsular contracture, although its use in this setting remains off-label. Conventional approaches involve placing a single ADM layer during first-stage tissue expander placement. The authors present a novel approach that utilizes ADM in both stages of tissue expander/implant-based breast reconstruction, creating a bilayer ADM construct to enhance soft tissue support. This study aimed to describe the technique of serially stacked ADM in implant-based breast reconstruction and assess its preliminary safety profile. A retrospective review was conducted of all patients who received bilayer ADM in expander/implant-based breast reconstruction by a single surgeon between July 2020 and May 2024. Patient demographics, operative details, time between stages, follow-up duration, and major complications were assessed. Nineteen patients were included in this study. The mean age was 46 ± 8.6 years, and the mean BMI was 21.6 ± 2.85 kg/m². Two patients had a history of radiation therapy. Seventeen reconstructions were prepectoral, and 2 were subpectoral. The average time from expander placement to implant exchange was 180 days. The average follow-up after the second stage was 10.8 months. No patients required reoperation or hospital readmission after either stage, and no major intraoperative or postoperative complications were reported. Preliminary findings from this cohort suggest that stacked ADM may be considered a safe and effective adjunct for enhancing soft tissue coverage in implant-based breast reconstruction. Larger prospective studies are needed to confirm these early results. Level of Evidence: 4 (Therapeutic).