Pre-pectoral breast reconstruction without the use of acellular dermal matrix: a 3-year review
Luke Poveromo, MD, Philipp Franck, MD, Angela Ellison, David Otterburn, MD
Division of Plastic Surgery, Weill Cornell Medical College, New York, NY, Weill Cornell Medical College, New York, NY
Background: Acellular dermal matrix (ADM) is frequently utilized during pre-pectoral tissue expander-based breast reconstruction. However, there has been a paucity of literature describing the experience of pre-pectoral reconstruction without the accompanying use of ADM. We seek to highlight our institutional experience with immediate pre-pectoral tissue expander placement without the use of acellular dermal matrix (ADM) in breast reconstruction.
Methods: A retrospective, single institution review of patient records was performed to identify all patients who underwent either skin sparing or nipple sparing mastectomy with immediate tissue expander placement without the use of acellular dermal matrix. Demographics including age, body mass index, co-morbidities, history of smoking or steroid use, perioperative radiation or chemotherapy, intraoperative detail, and complication profiles during the tissue expander stage were retrospectively collected and analyzed. At the time of tissue expander placement, all mastectomy flaps were evaluated clinically and with indocyanine green laser angiography. Post-operative infection was defined as any patient who received post-operative antibiotics to treat newly developed erythema. Post-operative skin necrosis was clinically defined as any compromise in skin quality requiring initiation of topical treatment (i.e. silver sulfadiazine).
Results: Between 2017-2020, 63 patients (for a total of 108 breasts) underwent either skin sparing (16%) or nipple sparing mastectomy (84%) with immediate pre-pectoral tissue expander without ADM placement. 14% of breasts developed post-operative cellulitis, 19% of breasts developed skin compromise, and 5% required a post-operative revisional procedure that did not result in immediate expander explant. There was a 13% (n=14 breasts) explant rate occurring at a mean time of 74 days. Of those breasts who developed skin compromise, 45% of went on to require eventual explant. Patients in the study were followed for an average of 6.3 months.
Conclusions: Immediate pre-pectoral breast reconstruction using tissue expanders without ADM offers a viable alternative to established reconstructive paradigms. The major complication rate for pre-pectoral reconstruction without the use of ADM (17%) was found to be comparable to our historical subpectoral tissue expander reconstruction with ADM use. Tissue expander explant rates were also comparable between the pre-pectoral without ADM (13%) and the subpectoral with ADM cohorts. These preliminary data suggest that immediate breast reconstruction with tissue expander placement without accompanying acellular dermal matrix is viable alternative in the breast reconstructive algorithm.
Back to 2021 Abstracts