Effect of Acellular Dermal Matrix in Postoperative Outcomes in Tissue Expander Breast Reconstruction After Immediate Mastectomy
Abstract
Simple Summary
Abstract
1. Introduction
1.1. Patients and Methods
1.2. Statistical Analysis
2. Results
3. Discussion
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Michele, P.G.; Francesco, S.; Nicolò, B.; Eugenio, G.; Edoardo, R. Breast reconstruction with breast implants. Acta Biomed. 2018, 89, 457–462. [Google Scholar]
- Uroskie, T.W.; Colen, L.B. History of Breast Reconstruction. Semin Plast. Surg. 2004, 18, 65–69. [Google Scholar] [CrossRef]
- Manrique, O.J.; Charafeddine, A.; Abu-Ghname, A.; Banuelos, J.; Jacobson, S.R.; Martinez-Jorge, J.; Nguyen, M.-D.; Harless, C.; Tran, N.V.; Sharaf, B.; et al. Two-Staged Implant-Based Breast Reconstruction: A Long-Term Outcome Study in a Young Population. Medicina 2019, 55, 481. [Google Scholar] [CrossRef]
- de Faria Castro Fleury, E.; Jasmin Huanca Bernal, K.; Lucena Miranda Madeiro, A.; Luis Cervera Ocana, W.; Carlos Vendramini Fleury, J.; Caobianco, L. Side effects in breast implants related to radiotherapy in breast cancer reconstructive surgery. Tech. Innov. Patient Support Radiat. Oncol. 2021, 18, 8–11. [Google Scholar] [CrossRef]
- Ellsworth, W.A.; Hammer, J.; Luo, L.; Schumacher, A. Acellular Dermal Matrices in Breast Reconstruction: CARE Trial 5-Year Outcomes Data for More Than 9500 Patients. Plast. Reconstr. Surg. Glob. Open 2022, 10, e4258. [Google Scholar] [CrossRef]
- Potter, S.; Browning, D.; Savović, J.; Holcombe, C.; Blazeby, J.M. Systematic review and critical appraisal of the impact of acellular dermal matrix use on the outcomes of implant-based breast reconstruction. Br. J. Surg. 2015, 102, 1010–1025. [Google Scholar] [CrossRef] [PubMed]
- Kelley, R.S.; Duraes, E.F.R.; Scomacao, I.R.; Van Dijck, P.; Fahradyan, V.; Rambhia, S.; Moreira, A.A.; Djohan, R.S.; Schwarz, G.S.; Bernard, S.L. A retrospective review of submuscular implant-based breast reconstruction: The influence of dermal matrix (ADM) on complications and aesthetic outcomes. J. Plast. Reconstr. Aesthetic Surg. 2022, 75, 4117–4124. [Google Scholar] [CrossRef] [PubMed]
- Salibian, A.A.; Bekisz, J.M.; Kussie, H.C.; Thanik, V.D.; Levine, J.P.; Choi, M.; Karp, N.S. Do We Need Support in Prepectoral Breast Reconstruction? Comparing Outcomes with and without ADM. Plast. Reconstr. Surg. Glob. Open 2021, 9, e3745. [Google Scholar] [CrossRef]
- Israeli, R. Complications of acellular dermal matrices in breast surgery. Plast. Reconstr. Surg. 2012, 130 (Suppl. S2), 159S–172S. [Google Scholar] [CrossRef]
- Murphy, D.; O’Donnell, J.P.; Ryan, E.J.; Lane O’Neill, B.; Boland, M.R.; Lowery, A.J.; Kerin, M.J.; McInerney, N.M. Immediate Breast Cancer Reconstruction with or without Dermal Matrix or Synthetic Mesh Support: A Review and Network Meta-Analysis. Plast. Reconstr. Surg. 2023, 151, 563e–574e. [Google Scholar] [CrossRef] [PubMed]
- Rose, J.F.; Zafar, S.N.; Ellsworth Iv, W.A. Does Acellular Dermal Matrix Thickness Affect Complication Rate in Tissue Expander Based Breast Reconstruction? Plast. Surg. Int. 2016, 2016, 2867097. [Google Scholar] [CrossRef]
- Berry, T.; Brooks, S.; Sydow, N.; Djohan, R.; Nutter, B.; Lyons, J.; Dietz, J. Complication Rates of Radiation on Tissue Expander and Autologous Tissue Breast Reconstruction. Ann. Surg. Oncol. 2010, 17, 202–210. [Google Scholar] [CrossRef] [PubMed]
- Elizalde-Méndez, Á.; Esparza-Arias, N.; Bargalló-Rocha, J.E.; Maciel-Miranda, A.; Figueroa-Padilla, J.; Drucker-Zertuche, M.; Bandala-Jacques, A.; Barquet-Muñoz, S.A. Factors associated to complications in reconstruction in patients with breast cancer treated with mastectomy. Gac. Mex. Oncol. 2021, 20, 20–26. [Google Scholar] [CrossRef]
- Palve, J.S.; Luukkaala, T.H.; Kääriäinen, M.T. Predictive risk factors of complications in different breast reconstruction methods. Breast Cancer Res. Treat. 2020, 182, 345–354. [Google Scholar] [CrossRef]
- Poveromo, L.P.; Franck, P.; Ellison, A.; Janhofer, D.E.; Asadourian, P.A.; Otterburn, D.M. Prepectoral Breast Reconstruction Without the Use of Acellular Dermal Matrix: A 3-Year Review. Ann. Plast. Surg. 2022, 88, S205–S208. [Google Scholar] [CrossRef] [PubMed]
- Salibian, A.A.; Frey, J.D.; Bekisz, J.M.; Nolan, S.; Choi, M. Ischemic complications after nipple-sparing mastectomy: Predictors of reconstructive failure in implant-based reconstruction and implications for decision-making. Plast. Reconstr. Surg. Glob. Open 2019, 7, e2280. [Google Scholar] [CrossRef] [PubMed]
- Pires, G.; Marquez, J.L.; Memmott, S.; Sudduth, J.D.; Moss, W.; Eddington, D.; Karp, N.S.; Choi, M. Early Complications after Prepectoral Tissue Expander Placement in Breast Reconstruction with and without Acellular Dermal Matrix. Plast. Reconstr. Surg. 2024, 153, 1221–1229. [Google Scholar] [CrossRef]
- Maruccia, M.; Giudice, G.; Nacchiero, E.; Cazzato, G.; De Luca, G.M.; Gurrado, A.; Testini, M.; Elia, R. Pre-Pectoral Tissue Expander and Acellular Dermal Matrix for a Two-Stage Muscle Sparing Breast Reconstruction: Indications, Surgical Technique and Clinical Outcomes with Histological and Ultrasound Follow-Up—A Population-Based Cohort Study. Aesthetic Plast. Surg. 2025, 49, 1938–1946. [Google Scholar] [CrossRef]
- Asaad, M.; Selber, J.C.; Adelman, D.; Baumann, D.; Hassid, V.; Crosby, M. Allograft vs Xenograft Bioprosthetic Mesh in Tissue Expander Breast Reconstruction: A Blinded Prospective Randomized Controlled Trial. Aesthetic Surg. J. 2021, 41, NP1931–NP1939. [Google Scholar] [CrossRef]
- Nouri, A.; Nwaoz, B.; Ghosh, K.; Marquez, J.; Mironis, A.; Huston, T.; Ganz, J.; Bui, D.; Khan, S. Association between ADM Thickness and Complication Risks in Tissue Expander Breast Reconstruction. Plast. Reconstr. Surg. Glob. Open 2021, 9, 42–43. [Google Scholar] [CrossRef]
- Brunbjerg, M.E.; Jensen, T.B.; Overgaard, J.; Christiansen, P.; Damsgaard, T.E. Comparison of one-stage direct-to-implant with acellular dermal matrix and two-stage immediate implant-based breast reconstruction-a cohort study. Gland. Surg. 2021, 10, 207–218. [Google Scholar] [CrossRef]
- Choi, Y.S.; You, H.J.; Lee, T.Y.; Kim, D.W. Comparing Complications of Biologic and Synthetic Mesh in Breast Reconstruction: A Systematic Review and Network Meta-Analysis. Arch. Plast. Surg. 2023, 50, 3–9. [Google Scholar]
- Zhao, X.; Wu, X.; Dong, J.; Liu, Y.; Zheng, L.; Zhang, L. A Meta-analysis of Postoperative Complications of Tissue Expander/Implant Breast Reconstruction Using Acellular Dermal Matrix. Aesthetic Plast. Surg. 2015, 39, 892–901. [Google Scholar]
- Lee, K.T.; Mun, G.H. Updated Evidence of Acellular Dermal Matrix Use for Implant-Based Breast Reconstruction: A Meta-analysis. Ann. Surg. Oncol. 2016, 23, 600–610. [Google Scholar]
- Marquez, J.L.; French, M.; Ormiston, L.; Pires, G.; Martheswaran, T.; Eddington, D.; Tuncer, F.; Agarwal, J.P.; Kwok, A.C. Outcomes after tissue expander exchange to implant in two- stage prepectoral breast reconstruction with and without acellular dermal matrix: A retrospective cohort study. J. Plast. Reconstr. Aesthetic Surg. 2024, 89, 97–104. [Google Scholar] [CrossRef]
- Yang, C.E.; Park, K.H.; Lee, D.W.; Lew, D.H.; Song, S.Y. Does acellular dermal matrix expand in response to tissue expander inflation? Arch. Plast. Surg. 2019, 46, 34–38. [Google Scholar] [CrossRef]
- Smith, J.M.; Broyles, J.M.; Guo, Y.; Tuffaha, S.H.; Mathes, D.; Sacks, J.M. Human acellular dermis increases surgical site infection and overall complication profile when compared with submuscular breast reconstruction: An updated meta-analysis incorporating new products. J. Plast. Reconstr. Aesthetic Surg. 2018, 71, 1547–1556. [Google Scholar] [CrossRef] [PubMed]
- Belmonte, B.M.; Campbell, C.A. Safety Profile and Predictors of Aesthetic Outcomes After Prepectoral Breast Reconstruction With Meshed Acellular Dermal Matrix. Ann. Plast. Surg. 2021, 86 (Suppl. S5), S585–S592. [Google Scholar] [CrossRef] [PubMed]
- Ibrahim, A.M.S.; Koolen, P.G.L.; Ganor, O.; Markarian, M.K.; Tobias, A.M.; Lee, B.T.; Lin, S.J. Does acellular dermal matrix really improve aesthetic outcome in tissue expander/implant-based breast reconstruction? Aesthetic Plast. Surg. 2015, 39, 359–368. [Google Scholar] [CrossRef]
- Spear, S.L.; Parikh, P.M.; Reisin, E.; Menon, N.G. Acellular dermis-assisted breast reconstruction. Aesthetic Plast. Surg. 2008, 32, 418–425. [Google Scholar] [CrossRef]
- Pruimboom, T.; Schols, R.M.; Van Kuijk, S.M.; Van der Hulst, R.R.; Qiu, S.S. Indocyanine green angiography for preventing postoperative mastectomy skin flap necrosis in immediate breast reconstruction. Cochrane Database Syst. Rev. 2020, 4, CD013280. [Google Scholar] [CrossRef]
- Fadell, N.; Laurent, F.; Sanka, S.A.; Ochoa, E.; Yaeger, L.; Li, X.; Wood, M.D.; Sacks, J.M.; Badran, S. The Utility of Indocyanine Green Angiography in Breast Reconstruction to Detect Mastectomy Skin Flap Necrosis and Free Flap Perfusion: An Umbrella Review. Bioengineering 2024, 11, 1025. [Google Scholar] [CrossRef] [PubMed]
- Saorín-Gascón, E.; Nova-Tayant, Ó.; Moreno-Villalba, R.A.; García-Contreras, J.d.D.; Fernández-Pascual, C.J.; Mora-Ortíz, A.M.; Servet-Pérez de Lema, M.d.C.; Quiles-Hevia, A.; Piñero-Madrona, A. Optimizing Outcomes in Breast Reconstruction: The Role of Hormonal Therapy Management. Cancers 2025, 17, 672. [Google Scholar] [CrossRef] [PubMed]
Overall Series (N = 87) | Prepectoral (N = 34) | Retropectoral (N = 52) | p Value | |
---|---|---|---|---|
Age | 50 (24–70) | 52 (24–62) | 49 (25–70) | 0.234 |
HTN | 20 (23) | 5 (15.2) | 15 (27.8) | 0.174 |
DLP | 17 (19.5) | 4 (12.1) | 13 (24.1) | 0.172 |
BMI | 24 (15.5–39) | 24.48 (20–39) | 23.50 (15.5–34.8) | 0.249 |
Smoking | 31 (35.6) | 11 (33.3) | 20 (37) | 0.726 |
DM | 5 (5.7) | 1 (3) | 4 (7.4) | 0.395 |
Histological classification | 0.487 | |||
LCIS | 1 (1.1) | - | 1 (1.9) | |
DCIS | 9 (10.3) | 2 (6.1) | 7 (13) | |
ILC | 6 (6.9) | 3 (9.1) | 3 (5.6) | |
IDC | 65 (74.7) | 27 (81.8) | 38 (70.4) | |
High risk lesions | 6 (6.9) | 1 (3) | 5 (9.3) | |
Molecular classification | 0.435 | |||
Luminal A | 36 (41.4) | 13 (39.4) | 23 (42.6) | |
Luminal B | 29 (33.39 | 10 (30.3) | 19 (35.2) | |
HER+ | 10 (11.5) | 6 (18.2) | 4 (7.4) | |
Basal like | 6 (6.9) | 3 (9.1) | 3 (5.6) | |
Unclassifiable | 6 (6.9) | 1 (3) | 5 (9.3) | |
LNI | 26 (29.9) | 12 (36.4) | 14 (25.9) | 0.302 |
NACT | 15 (17.2) | 10 (30.3) | 5 (9.3) | 0.012 |
RT | 34 (39.1) | 14 (42.4) | 20 (37) | 0.617 |
ACT | 34 (39.1) | 15 (45.5) | 19 (35.2) | 0.341 |
HT | 70 (80.5) | 26 (78.8) | 4 (81.5) | 0.759 |
ADM | 0.380 | |||
None | 50 (57.5) | 17 (51.5) | 33 (61.1) | |
Fortiva | 16 (18.4) | 16 (48.5) | - | |
Tutomesh | 21 (24.1) | - | 21 (38.9) | |
Plane | ||||
Prepectoral | 33 (37.9) | |||
Retropectoral | 54 (62.1) | |||
Volume | 400 (200–600) | 400 (200–500) | 400 (300–600) | 0.240 |
Prepectoral (n = 33) | Retropectoral (n = 54) | |||||
---|---|---|---|---|---|---|
ADM (16) | No ADM (17) | p Value | ADM (21) | No ADM (33) | p Value | |
OC | 9 (56.3) | 3 (17.6) | 0.021 | 12 (57.1) | 9 (27.3) | 0.028 |
Seroma | 4 (25) | 1 (5.9) | 0.126 | 3 (14.3) | 4 (12.1) | 0.817 |
SSI | 8 (50) | 2 (11.8) | 0.017 | 5 (23.8) | 3 (9.1) | 0.138 |
Skin/NAC necrosis | 1 (6.3) | 0 | 0.295 | 4 (19) | 3 (9.1) | 0.288 |
Dehiscence | 7 (43.8) | 3 (17.6) | 0.103 | 6 (28.6) | 2 (6.1) | 0.023 |
Variable | Univariate | Multivariate | OR IC95 (Multivariate) |
---|---|---|---|
OC | |||
Smoking | p = 0.05 | p = 0.06 | - |
HT | p = 0.03 | p = 0.99 | - |
ADM | p = 0.021 | p = 0.254 | - |
SSI | |||
Smoking | p = 0.05 | p = 0.223 | - |
ADM | p = 0.017 | p = 0.029 | 7.62 (1.23–47) |
Variable | Univariate | Multivariate | OR IC95 (Multivariate) |
---|---|---|---|
OC | |||
LNI | p = 0.01 | p = 0.99 | - |
ADM | p = 0.028 | p = 0.05 | 3.34 (1.01–11.16) |
SSI | |||
Smoking | p = 0.04 | p = 0.05 | 2.45 (1.01–6.10) |
RT | p = 0.05 | p = 0.05 | 2.20 (0.98–15.02) |
Dehiscence | |||
LNI | p = 0.011 | p = 0.912 | - |
ADM | p = 0.023 | p = 0.05 | 6.04 (1.02–35.76) |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Nova-Tayant, Ó.; Saorín-Gascón, E.; Moreno-Villalba, R.A.; Mora-Ortiz, M.A.; Fernández-Pascual, C.J.; Vera-García, P.J.; Piñero-Madrona, A. Effect of Acellular Dermal Matrix in Postoperative Outcomes in Tissue Expander Breast Reconstruction After Immediate Mastectomy. Cancers 2025, 17, 3185. https://doi.org/10.3390/cancers17193185
Nova-Tayant Ó, Saorín-Gascón E, Moreno-Villalba RA, Mora-Ortiz MA, Fernández-Pascual CJ, Vera-García PJ, Piñero-Madrona A. Effect of Acellular Dermal Matrix in Postoperative Outcomes in Tissue Expander Breast Reconstruction After Immediate Mastectomy. Cancers. 2025; 17(19):3185. https://doi.org/10.3390/cancers17193185
Chicago/Turabian StyleNova-Tayant, Óscar, Eduardo Saorín-Gascón, Ramón A. Moreno-Villalba, María A. Mora-Ortiz, Clemente J. Fernández-Pascual, Pablo J. Vera-García, and Antonio Piñero-Madrona. 2025. "Effect of Acellular Dermal Matrix in Postoperative Outcomes in Tissue Expander Breast Reconstruction After Immediate Mastectomy" Cancers 17, no. 19: 3185. https://doi.org/10.3390/cancers17193185
APA StyleNova-Tayant, Ó., Saorín-Gascón, E., Moreno-Villalba, R. A., Mora-Ortiz, M. A., Fernández-Pascual, C. J., Vera-García, P. J., & Piñero-Madrona, A. (2025). Effect of Acellular Dermal Matrix in Postoperative Outcomes in Tissue Expander Breast Reconstruction After Immediate Mastectomy. Cancers, 17(19), 3185. https://doi.org/10.3390/cancers17193185