Author(s)

Claas Spengler^1*, Roland Mett¹, Frank Masberg¹, Peter M. Vogt², Tobias R. Mett²

¹Department of Plastic, Reconstructive Aesthetic Surgery, HELIOS Klinik Schwerin, Schwerin, Germany.
²Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany.

The aim of the study was to show significant differences regarding postoperative complications and outcomes using three different Acellular Dermal Matrices (ADM), namely Epiflex^®, Strattice^® and Braxon^®, in immediate implant-based subpectoral breast reconstruction cases. Background: The use of Acellular Dermal Matrices for implant-based breast reconstruction cases continues to evolve. There is a wide variety of products which differ significantly in their biological features. It remains unclear if and how these differences manifest in clinical practice. Methods: 82 cases of primary breast reconstruction in the Department of Plastic and Aesthetic Surgery of HELIOS Clinics Schwerin, Germany between 2010 and 2018 were analyzed. 25 patients received Strattice^® acellular dermal matrix (SADM), 22 cases Epiflex^® acellular dermal matrix (EADM) and the remaining 35 cases Braxon^® acellular dermal matrix (BADM). The mean follow-up was 1.8 years. Cases were analyzed regarding minor or major complications and rate of capsular contracture grade III or IV (Baker Classification). Results: The overall complication rate was 34.1% for all groups (SADM = 40%, EADM = 50%, BADM = 20%, p-value = 0.051). Of all cases, 6 patients underwent implant exchange or secondary autologous reconstruction due to capsular contracture (7.3%). The mean time between revision due to capsular contracture and reconstruction was 35.8 ± 14.4 months. 50% of patients, who developed capsular contracture, received postoperative radiation. Mean hospitalization time was 8.2 ± 3 days (SADM = 8 ± 3.2 days, EADM = 10 ± 2.8 days, BADM = 6 ± 1.3 days). There were no significant differences between all three groups for demographics, overall complication rate or capsular contracture. However, patients receiving Braxon^® matrix showed significantly fewer minor complications (p-value = 0.01). Moreover, patients receiving Braxon^® ADM showed a significantly lower time of hospitalization (p < 0.001). Conclusion: No significant differences regarding the overall complication rate were found between the three groups. Different biological features of ADM showed a weak influence on overall results. However, patients receiving Braxon^® ADM showed significantly lower minor complication rates and hospitalization time. In addition, these matrices showed a trend towards lower capsular contracture rates. The low rate of capsular contracture hints at possible advantages of ADM-use in direct-to-implant cases.

Breast Reconstruction, Acellular Dermal Matrix, ADM, Direct-to-Implant, DTI, Immediate Breast Reconstruction, IBR, Breast Cancer, Skin Sparing Mastectomy, EPIFLEX, Strattice, BRAXON

Spengler, C. , Mett, R. , Masberg, F. , Vogt, P. and Mett, T. (2021) Lessons Learned from Three Different Acellular Dermal Matrices in Direct-to-Implant Breast Reconstruction. Modern Plastic Surgery, 11, 22-35. doi: 10.4236/mps.2021.111004.