Breast Reconstruction with Implants and Tissue Expanders

This chapter details breast reconstruction following breast surgery. Over the past decade the number of women choosing reconstruction with tissue expanders and implants has steadily increased, while the percentage of women having autologous reconstruction has plateaued or fallen off. The authors explain the use of tissue expanders and implants and detail the advancements made in the ability to evaluate tissue in real-time intervals. Additional advances in technique, implant design, acellular dermal matrix, and fat grafting have improved the aesthetic results of breast reconstruction even further, and these techniques are discussed in detail. The authors address patient-specific indications and contraindications, the use of acellular dermal matrix, the assessment of the defect and perfusion, patient markings, room setup, and operative technique.

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Citation Analysis in Breast Reconstruction Publications Between 2000 and 2010

Plastic Surgery ◽

10.1177/22925503211049947 ◽

2021 ◽

pp. 229255032110499

Author(s):

Rebecca Miller ◽

Sheina Macadam ◽

Daniel Demsey

Keyword(s):

Breast Reconstruction ◽

Citation Analysis ◽

Case Series ◽

Acellular Dermal Matrix ◽

Fat Grafting ◽

Fat Graft ◽

Level Of Evidence ◽

Dermal Matrix ◽

Number Of Patients ◽

Acellular Dermal

Introduction and Purpose: Breast reconstruction is an active area of plastic surgery research. Citation analysis allows for quantitative analysis of publications, with more citations presumed to indicate greater influence. We performed citation analysis to evaluate the most cited papers on breast reconstruction between 2000 to 2010 to identify contemporary research trends. Methods: The SCI-EXPANDED database was used to identify the 50 most cited papers. Data points included authorship, publication year, publication journal, study design, level of evidence, number of surgeons/institutions, center of surgery, primary outcome assessed, implant/flap/acellular dermal matrix/fat graft, acellular dermal matrix brand and use with implants/flaps, fat graft use with implants/flaps, unilateral/bilateral, one-/two-stage, immediate/delayed, number of patients/procedures, complications. Descriptive analysis of trends was performed based on results. Results: 20% of papers were published in 2006, 16% in 2007 and 12% in both 2004/2009. 66% were published in Plastic and Reconstructive Surgery. The majority were retrospective or case series, and of Level III or IV evidence. The one Level I study was a prospective multicenter trial. 21 and 7 papers discussed procedures by single/multiple surgeons, respectively. Results from single/multiple centers were discussed in 18 and 6 papers, respectively. 30 papers discussed implant-based reconstruction, 22 papers flap-based (19 microsurgical), 15 papers acellular dermal matrix, and five papers fat grafting. The primary focus in the majority was complications or outcomes. Conclusion: Our analysis demonstrates continually evolving techniques in breast reconstruction. However, there is notable lack of high quality evidence to guide surgical decision-making in the face of increasing surgical options.

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Prosthetic-Based Breast Reconstruction

10.2310/ps.10088 ◽

2020 ◽

Author(s):

Jonathan Nguyen ◽

Justin Williams ◽

Albert Losken

Keyword(s):

Breast Reconstruction ◽

Breast Implant ◽

Tissue Expander ◽

Acellular Dermal Matrix ◽

Large Cell ◽

Fat Grafting ◽

Immediate Reconstruction ◽

Dermal Matrix ◽

Prosthetic Reconstruction ◽

Acellular Dermal

Prosthetic reconstruction is the most popular option for breast reconstruction after mastectomy. There are several different techniques, such as prepectoral versus subpectoral placement, and delayed versus immediate reconstruction, each with their own sets of risks and benefits. With the advent of improved implant technology, acellular dermal matrix, and fat grafting, prepectoral direct to implant has become an accepted and increasingly popular method of reconstruction, with similar to improved complication rates and outcomes as traditional staged tissue expander reconstruction. Prosthetic reconstruction has had some recent controversies, including breast implant associated anaplastic large cell lymphoma and breast implant illness, and many future studies are being directed towards these topics. This review contains 5 figures, and 53 references. Keywords: breast reconstruction, breast implant, acellular dermal matrix, prepectoral reconstruction, tissue expander, fat grafting, capsular contracture, immediate reconstruction, breast implant associated anaplastic large cell lymphoma, breast implant illness

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Ancillary considerations in breast surgery

10.1093/med/9780199682874.003.0097 ◽

2021 ◽

pp. 1145-1150

Author(s):

Emily G. Clark ◽

Melissa A. Mueller ◽

Gregory R.D. Evans

Keyword(s):

Breast Reconstruction ◽

Breast Surgery ◽

Capsular Contracture ◽

Acellular Dermal Matrix ◽

Fat Grafting ◽

Dermal Matrix ◽

Oncological Safety ◽

Acellular Dermal ◽

Radiographic Changes ◽

Suspicious Lesions

Debated topics and new and evolving techniques in breast surgery are discussed in this chapter. Antibiotics and the use of closed-suction drains vary among surgeons, but the existing evidence favours discontinuation of antibiotics within 24 hours in most cases, and the indications for drains are limited but include breast reconstruction with acellular dermal matrix (ADM). ADM is a biological tissue substitute with many applications in breast surgery. The product selected and surgical technique used are often case specific; cost and patient anatomy play major roles. Although not suitable for all patients, ADM is an asset to prosthetic breast reconstruction. In addition, ADM is useful in the correction of breast surgery complications, including malpositioning and capsular contracture. It may be combined with fat grafting to mask rippling. Fat grafting, or lipomodelling, is an evolving science with promising results. Technique is critical for good results, and is described in this chapter. Radiographic changes after fat grafting are usually discernible from suspicious lesions, and growing evidence supports the oncological safety of this procedure

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Evidence for the Use of Acellular Dermal Matrix in Implant-Based Breast Reconstruction

Seminars in Plastic Surgery ◽

10.1055/s-0039-1696986 ◽

2019 ◽

Vol 33 (04) ◽

pp. 229-235 ◽

Cited By ~ 3

Author(s):

Paula R. Gravina ◽

Rowland W. Pettit ◽

Matthew J. Davis ◽

Sebastian J. Winocour ◽

Jesse C. Selber

Keyword(s):

Breast Reconstruction ◽

Capsular Contracture ◽

Acellular Dermal Matrix ◽

Patient Specific ◽

Dermal Matrix ◽

Biological Scaffolds ◽

Dermal Matrices ◽

Tissue Grafts ◽

Cellular Components ◽

Acellular Dermal

AbstractAcellular dermal matrices (ADMs) are tissue grafts that have been specially processed to remove all cellular components. These machined biological scaffolds have become popular in a variety of surgical settings due to their rapid incorporation into living tissue. As ADMs are highly malleable and cause minimal inflammation, they have come to serve as a useful tool in implant-based breast reconstruction procedures. The major benefits of using an ADM in this setting include superior initial breast contouring, decreased risk of capsular contracture after implant insertion, and consistent sustained positioning of the reconstructed breast. Despite these advantages, these tissue grafts are foreign to the host, and postoperative complications following ADM insertion, including infection and seroma, have been well documented. When considering using ADMs in this setting, it is important to first consider patient-specific factors that could preclude their use, such as low body mass index, small breasts, or a history of radiation exposure to the breast tissue. ADM grafts are also expensive, which may present another barrier to their use. Review of the literature ultimately suggests a continued role for ADMs in implant-based breast reconstruction, and continued research in this field is warranted.

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The Prospects of Using Meshes in Imediate Implant - Based Breast Reconstructions

Materiale Plastice ◽

10.37358/mp.17.3.4862 ◽

2017 ◽

Vol 54 (3) ◽

pp. 414-417 ◽

Cited By ~ 1

Author(s):

Cristina Iulia Filip ◽

Sorin Berbece ◽

Laura Raducu ◽

Ioan Petre Florescu ◽

Valeriu Ardeleanu ◽

...

Keyword(s):

Breast Reconstruction ◽

Surgical Techniques ◽

Acellular Dermal Matrix ◽

Dermal Matrix ◽

Biofilm Bacteria ◽

The Aesthetic ◽

The Many ◽

The Impact ◽

Acellular Dermal ◽

Reconstructed Breast

Breast reconstruction involves two major conditions: to be oncologically safe and to respect the aesthetic of the reconstructed breast. Moreover, every healthcare system in the world manifests a keen tendency to cut back on medical costs, which influences our surgical techniques and breast reconstruction procedures. The use of biological matrices like the acellular dermal matrix has become an acknowledged alternative in implant-based breast reconstruction, in spite of the many impediments and controversies that surround it. However, these matrices are costly and less attainable as compared to synthetic meshes that are conservative with resources and unyielding to the formation of biofilm bacteria. Accordingly, we decided to research the impact of synthetic meshes in implant-based breast reconstruction.

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Acellular dermal matrix as filler in breast-conserving surgery: warnings for a careful use

World Journal of Surgical Oncology ◽

10.1186/s12957-020-02109-x ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Gianluca Franceschini ◽

Riccardo Masetti

Keyword(s):

Acellular Dermal Matrix ◽

Breast Conserving Surgery ◽

Human Origin ◽

Dermal Matrix ◽

Adequate Knowledge ◽

Aesthetic Results ◽

Dermal Matrices ◽

Acellular Dermal ◽

Human Acellular Dermal Matrix ◽

Host Tissues

AbstractAcellular dermal matrices are biological materials of porcine, bovine, or human origin used as scaffold for reconstructive purpose in plastic surgery; these materials are well-tolerated and safely integrated in host tissues without causing resorption, contracture, and encapsulation thanks to their low antigenicity.Recently, human acellular dermal matrix has been used as a filler in breast-conserving surgery to improve aesthetic results. Adequate knowledge of biomaterials properties, appropriate skill, and careful compliance with some specific recommendations are mandatory in order to optimize outcomes and obtain a work of success.

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Porcine Acellular Dermal Matrix Increases Fat Survival Rate After Fat Grafting in Nude Mice

Aesthetic Plastic Surgery ◽

10.1007/s00266-021-02402-4 ◽

2021 ◽

Author(s):

Xinhang Dong ◽

Mingzi Zhang ◽

Xiaolei Jin

Keyword(s):

Survival Rate ◽

Nude Mice ◽

Acellular Dermal Matrix ◽

Fat Grafting ◽

Dermal Matrix ◽

Porcine Acellular Dermal Matrix ◽

Acellular Dermal ◽

Fat Survival

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The Comparison of Breast Reconstruction Using Two Types of Acellular Dermal Matrix after Breast-Conserving Surgery

Journal of Clinical Medicine ◽

10.3390/jcm10153430 ◽

2021 ◽

Vol 10 (15) ◽

pp. 3430

Author(s):

Jeongshin An ◽

Hyungju Kwon ◽

Woosung Lim ◽

Byung-In Moon ◽

Nam Sun Paik

Keyword(s):

Breast Cancer ◽

Breast Reconstruction ◽

Acellular Dermal Matrix ◽

Breast Conserving Surgery ◽

The Body ◽

Surgical Time ◽

Dermal Matrix ◽

Specimen Weight ◽

Breast Shape ◽

Acellular Dermal

Breast reconstruction during breast-conserving surgery (BCS) can improve the breast shape. This study introduces breast reconstruction in BCS with two types of acellular dermal matrix (ADM). The study included 134 patients who underwent BCS due to breast cancer from February 2018 to May 2021. This study was conducted by one surgeon, and is the result of a three-year study. The patient group who underwent BCS using ADM was mainly targeted at patients with minor to severe defects after the operation. The average age of the patients was 51.8 years, and the body mass index (BMI) was 23.8 kg/m. The specimen weight was 30–120 g. The average surgical time, including reconstruction, was 100.4 min, combined with reconstruction. There were minor complications in six patients. The advantage of using ADM is that it can quickly correct the shape of the breast after conventional BCS surgery. Pellet-type ADM, rather than sheet-type, can create a breast shape similar to that before surgery. Breast reconstruction using ADM can be an easy and convenient method for making a better shape from BCS.

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