Immediate prepectoral breast reconstruction using an ADM with smooth round implants: A prospective observational cohort study

• Published in: Journal of plastic, reconstructive & aesthetic surgery Vol. 80; pp. 56 - 65
• Main Authors: di Pompeo, Fabio Santanelli, Firmani, Guido, Paolini, Guido, Amorosi, Vittoria, Briganti, Francesca, Sorotos, Michail
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.05.2023
• Subjects: Acellular Dermis; ADM; Adolescent; Adult; Aged; Aged, 80 and over; Braxon; Breast Neoplasms - surgery; Breast reconstruction; Direct-to-implant; Female; Humans; Implant-based reconstruction; Mammaplasty - methods; Mastectomy - methods; Middle Aged; Prepectoral; Prospective Studies; Young Adult; Braxon; ADM; Direct-to-implant; Implant-based reconstruction; Prepectoral; Breast reconstruction
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2023.02.014

Prepectoral breast reconstruction using acellular dermal matrices (ADMs) is well established and used in candidates for nipple/skin-sparing mastectomies; it is based on many different matrices and a great variability in breast implant selection. We describe our experience and clinical outcomes using Braxon® ADMs and smooth round breast implants. Females aged 18–80 years who underwent mastectomies with immediate prepectoral reconstruction between April 2019 and April 2021 were prospectively included. Complications were classified as mastectomy-related (hematoma, necrosis) or reconstruction-related (seroma, infection, red breast syndrome). Binary logistic regression analysis was performed to assess correlation between complication rate and selected variables, which were analyzed per breast with Kruskal–Wallis H test. Fifty-eight patients (102 breasts) received 45 bilateral and 12 unilateral procedures. Drains collected 485.9 cc [range: 100–1260] and were removed 15.7 days [range: 6–29] postoperatively. We report 41 complications (40.2%): 33 mastectomy-related, 8 reconstruction-related. Reoperation occurred in 14 patients: 7 wound debridement and revisions under local anesthesia; and 7 explantation. Implant loss rate was 6.8%. Mastectomy and reconstruction complications were not correlated with any variable. In conclusion, we found prepectoral reconstruction with Braxon® ADMs and smooth round implants to be associated with acceptable complication rates that are not influenced by any patient- or surgery-related factors. Drainage volume is comparable to other breast implant reconstructive techniques, but drains are left in place for longer.