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Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
ADM-Assisted Breast Reconstruction vs Micro-Polyurethane Foam-Covered Implants in the Prepectoral Space: A
Sergio Miranda1,2, Luca Mazzocconi1,2, Giulio Tarantino3,4,5
1Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, Milan, Italy.
Background:
Prepectoral breast reconstruction using acellular dermal matrices (ADMs) or micro-polyurethane foam-covered breast implants have emerged as commonly used surgical techniques. Although the use of both ADMs and micro-polyurethane foam-covered implants in prepectoral breast reconstruction are widely described in literature, comparative data remains limited.
Objectives:
Our goal was to compare the short-term and medium-term clinical outcomes as well as the patient-reported outcomes in patients undergoing direct-to-implant (DTI) prepectoral breast reconstruction using ADM versus micro-polyurethane foam-covered implants.
Methods:
A retrospective matched cohort study was conducted on 64 patients (32 ADM-wrapped and 32 micro-polyurethane foam-covered breast implants). Patients were matched based on prior surgery, adjuvant radiotherapy, and implant volume. Demographic and oncological characteristics, surgical variables, short- and medium-term outcomes, and patient-reported outcomes were compared between the two groups.
Results:
The micro-polyurethane group had significantly older patients (median age 53 vs. 47 years; p = 0.036). Periprosthetic fluid collection (31% vs. 3%; p = 0.006) and need for percutaneous fluid aspiration (38% vs. 9%; p = 0.016) occurred significantly more often in the ADM group. The indication for further surgery was also higher with ADM (47% vs. 19%; p = 0.031). Patient satisfaction showed a non-significant trend favoring micro-polyurethane implants in satisfaction with outcome domain (mean: 89 vs. 82; p = 0.060).
Conclusions:
Both ADM-assisted reconstructions and micro-polyurethane implants demonstrated high performance in the short and medium term, and they were associated to high patient satisfaction with reconstruction. However, micro-polyurethane implants were associated with fewer periprosthetic fluid collections and a lower need for percutaneous fluid aspirations compared to the ADM group. These findings suggest a potential advantage in terms of reduced postoperative complications.
Level Of Evidence Iii:
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
