Immediate post-mastectomy prepectoral breast reconstruction with animal derived acellular dermal matrices: A systematic review

Annachiara Tellarini; Leonardo Garutti; Martina Corno; Federico Tamborini; Ferruccio Paganini; Veronica Fasoli; Danilo Di Giovanna; Luigi Valdatta

doi:10.1016/j.bjps.2023.08.020

Immediate post-mastectomy prepectoral breast reconstruction with animal derived acellular dermal matrices: A systematic review

J Plast Reconstr Aesthet Surg. 2023 Nov:86:94-108. doi: 10.1016/j.bjps.2023.08.020. Epub 2023 Aug 24.

Authors

Annachiara Tellarini¹, Leonardo Garutti², Martina Corno², Federico Tamborini³, Ferruccio Paganini², Veronica Fasoli², Danilo Di Giovanna², Luigi Valdatta²

Affiliations

¹ Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy. Electronic address: annachiara.tellarini2018@gmail.com.
² Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.
³ Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Microsurgery and Hand Surgery Unit, ASST Settelaghi Varese, Varese, Italy.

PMID: 37716255
DOI: 10.1016/j.bjps.2023.08.020

Abstract

Background: Animal-derived acellular dermal matrices (ADMs) are increasingly being used in prepectoral direct-to-implant (DTI) breast reconstruction. However, the indications and complication profile associated with this type of reconstruction remain unclear. This study aimed to perform a systematic review of the available literature on the use of animal-derived ADM in prepectoral DTI breast reconstruction.

Methods: Three different literature databases, namely, PubMed, Web of Sciences, and Embase were screened using the following keywords: "immediate" AND "pre-pectoral" OR "prepectoral" AND "ADM breast reconstruction." Animal-derived ADM used (porcine - Braxon® and non-Braxon® - and bovine - Surgimend®) anthropometric information, clinical data, and complications profile were considered.

Results: A total of 340 articles were initially identified, of which only 45 articles (5089 patients and 6598 reconstructed breasts) satisfied our inclusion criteria. The most widely used ADM was Braxon® in the context of conservative mastectomies. In most studies, a subcutaneous layer > 1 cm and lack of previous radiotherapy were considered prerequisites for this type of reconstruction. An increased risk of complications was found in smokers, patients who underwent radiation treatment, patients with high breast volumes, and patients with cancers requiring axillary dissection. Data related to the role of diabetes, high body mass index, and breast implant size on surgical outcomes were instead inconcludent. Age was not directly proportional to the complications.

Conclusion: The complications associated with different animal-derived ADMs are generally comparable. The profile of patients required for eligibility for this type of reconstruction appears to have been identified and is in line with current recommendations.

Keywords: Acellular Dermal Matrix; Breast cancer; Breast implant; Breast reconstruction; Muscle-sparing; Prepectoral.

Publication types

Systematic Review
Review

MeSH terms

Acellular Dermis*
Animals
Breast Implantation* / adverse effects
Breast Implants*
Breast Neoplasms* / etiology
Breast Neoplasms* / surgery
Cattle
Female
Humans
Mammaplasty* / adverse effects
Mastectomy
Retrospective Studies
Swine