Complication Rate of Prepectoral Implant-based Breast Reconstruction Using Human Acellular Dermal Matrices

Maria Lucia Mangialardi; Marzia Salgarello; Pasquale Cacciatore; Ilaria Baldelli; Edoardo Raposio

doi:10.1097/GOX.0000000000003235

Complication Rate of Prepectoral Implant-based Breast Reconstruction Using Human Acellular Dermal Matrices

Plast Reconstr Surg Glob Open. 2020 Dec 3;8(12):e3235. doi: 10.1097/GOX.0000000000003235. eCollection 2020 Dec.

Authors

Maria Lucia Mangialardi¹, Marzia Salgarello¹, Pasquale Cacciatore¹, Ilaria Baldelli², Edoardo Raposio²

Affiliations

¹ Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore e Unità di Chirurgia Plastica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito 1, Rome 00168, Italy.
² Clinica di Chirurgia Plastica e Ricostruttiva, Ospedale Policlinico San Martino e Sezione di Chirurgia Plastica, Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate - DISC, Università degli Studi di Genova, L.go R. Benzi 10, 16132, Genova, Italy.

Abstract

Implant-based breast reconstruction (IBR) is currently the most frequently performed reconstructive technique post mastectomy. Even though submuscular IBR continues to be the most commonly used technique, mastectomy technique optimization, the possibility to check skin viability with indocyanine green angiography, the enhanced propensity of patients undergoing prophylactic mastectomies, and the introduction of acellular dermal matrices (ADMs) have paved the way to the rediscovery of the subcutaneous reconstruction technique. The aim of this article is to update the complication rate of immediate and delayed prepectoral IBR using human ADMs (hADMs).

Methods: A literature search, using PubMed, Medline, Cochrane, and Google Scholar database according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, was conducted to evaluate complication rates of prepectoral implant-based reconstructions using hADMs. The following MeSH terms were used: "prepectoral breast reconstruction acellular dermal matrix," "prepectoral breast reconstruction ADM," "human ADM breast reconstruction," and "human acellular dermal matrix breast reconstruction" (period: 2005-2020; the last search took place on April 2, 2020).

Results: This meta-analysis includes 1425 patients (2270 breasts) who had undergone immediate or delayed prepectoral IBR using different types of hADMs. The overall complication rate amounted to 19%. The most frequent complication was represented by infection (7.9%), followed by seroma (4.8%), mastectomy flap necrosis (3.4%), and implant loss (2.8%).

Conclusions: The overall complication rate was 19%. The most frequent complications were infection, seroma, and mastectomy flap necrosis, while capsular contracture was rare.