European Journal of Plastic Surgery

, Volume 40, Issue 3, pp 255–258 | Cite as

Long term follow-up on prepectoral ADM-assisted breast reconstruction: evidences after 4 years

  • Giorgio Berna
  • Simon J. Cawthorn
Case Report


Prepectoral implant-based breast reconstruction is on the rise because of the advantages related to preservation of the pectoralis major muscle. Indeed, this reconstructive procedure improves the aesthetic outcomes and the postoperative recovery time, avoiding the risk of breast animation and deformity. On the other hand, the subcutaneous implant positioning has higher risk of capsular contracture and for this reason, the subpectoral breast reconstruction has been preferred for many years; but the introduction of a pre-shaped acellular dermal matrix (ADM) which allows a complete implant coverage led to the onset of the new prepectoral technique, solving the problem of a stiff periprosthetic capsule formation. In fact, the use of ADMs in breast reconstruction has been shown to decrease the capsular contracture formation. Nevertheless, no long-term outcomes have been reported with the use of a pre-shaped ADM for prepectoral breast reconstruction. The authors present the first ten patients who had a prepectoral ADM-assisted breast reconstruction showing no evidences of capsular contracture after a median follow-up of 4 years.

Level of Evidence: Level V, therapeutic study.


Mammaplasty Prepectoral Muscle-sparing Acellular dermis Total wrapping Follow-up 


Compliance with ethical standards

Conflict of interest

Giorgio Berna and Simon Cawthorn declare that they have no conflict of interest.

Patient consent

Patients provided written consent before their inclusion in this study. Additional consent was obtained for the use of their images.

Ethical standards

For this type of retrospective study, formal consent from an ethics committee is not required. The retrospective analysis of such procedure in the first ten cases, focused on capsule contracture issue, was approved by our institutional review board.


No grants nor funds have been received for this study.

Supplementary material

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Online Resource 1 (AVI 16200 kb)
238_2017_1285_MOESM2_ESM.avi (9.7 mb)
Online Resource 2 (AVI 9960 kb)


  1. 1.
    Hammond DC, Schmitt WP, O'Connor EA (2015) Treatment of breast animation deformity in implant-based reconstruction with pocket change to the subcutaneous position. Plast Reconstr Surg 135(6):1540–1544CrossRefPubMedGoogle Scholar
  2. 2.
    Berna G, Cawthorn SJ, Papaccio G, Balestrieri N (2014) Evaluation of a novel breast reconstruction technique using the Braxon® acellular dermal matrix: a new muscle-sparing breast reconstruction. ANZ J Surg. doi: 10.1111/ans.12849 PubMedGoogle Scholar
  3. 3.
    Maruccia M, Mazzocchi M, Dessy LA, Onesti MG (2016) One-stage breast reconstruction techniques in elderly patients to preserve quality of life. Eur Rev Med Pharmacol Sci 20(24):5058–5066PubMedGoogle Scholar
  4. 4.
    Schmitz M, Bertram M, Kneser U, Keller AK, Horch RE (2013) Experimental total wrapping of breast implants with acellular dermal matrix: a preventive tool against capsular contracture in breast surgery? J Plast Reconstr Aesthet Surg 66(10):1382–1389CrossRefPubMedGoogle Scholar
  5. 5.
    Alfano C, Mazzocchi M, Scuderi N (2004) Mammary compliance: an objective measurement of capsular contracture. Aesthetic Plast Surg 28(2):75–79CrossRefPubMedGoogle Scholar
  6. 6.
    Reitsamer R, Peintinger F (2015) Prepectoral implant placement and complete coverage with porcine acellular dermal matrix: a new technique for direct-to-implant breast reconstruction after nipple-sparing mastectomy. J Plast Reconstr Aesthet Surg 68(2):162–167CrossRefPubMedGoogle Scholar
  7. 7.
    Becker H, Lind JG, Hopkins EG (2015) Immediate implant-based prepectoral breast reconstruction using a vertical incision. Plast Reconstr Surg Glob Open 3(6):e412CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Iqbal FM, Bhatnagar A, Vidya R (2016) Host integration of an acellular dermal matrix: Braxon mesh in breast reconstruction. Clin Breast Cancer. doi: 10.1016/j.clbc.2016.06.009 PubMedGoogle Scholar
  9. 9.
    Bernini M, Calabrese C, Cecconi L et al (2016) Subcutaneous direct-to-implant breast reconstruction: surgical, functional, and aesthetic results after long-term follow-up. Plast Reconstr Surg Glob Open 3(12):e574CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Bergmann PA, Becker B, Mauss KL et al (2014) Titanium-coated polypropylene mesh (TiLoop bra®)—an effective prevention for capsular contracture? Eur J Plast Surg 37:339–346CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Department of Plastic and Reconstructive SurgeryUlss 2, Ca’ Foncello General HospitalTrevisoItaly
  2. 2.Breast Care Center, North Bristol NHS TrustBristolUK

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