Advertisement

European Journal of Plastic Surgery

, Volume 42, Issue 2, pp 145–154 | Cite as

Prepectoral breast reconstruction using the Braxon® porcine acellular dermal matrix: a retrospective study

  • Marco GardaniEmail author
  • Francesco Simonacci
  • Giuseppina De Sario
  • Francesca Cattadori
  • Edoardo Raposio
  • Dante Palli
Original Paper
  • 31 Downloads

Abstract

Background

Breast cancer is the leading cause of death attributable to cancer among women worldwide. Breast reconstruction has become an integrated part of breast cancer treatment due to long-term psychosexual health factors and its importance to breast cancer survivors. Muscle-sparing techniques using an acellular dermal matrix (ADM) (Braxon; DECO med s.r.l., Venice, Italy) can be considered a possible alternative to immediate reconstruction or two-step reconstruction for patients with medium breasts who want to preserve their natural breast shape.

Methods

We performed a retrospective analysis of reconstructions using a Braxon porcine-derived ADM at the Breast Unit of the University Hospital of Parma and the Breast Unit of Piacenza Hospital from January 2015 to September 2017. The objective was to evaluate the benefits and complications resulting from this technique.

Results

We treated 42 patients and performed a total of 51 muscle-sparing reconstructions using the Braxon porcine-derived ADM. The incidence of cutaneous necrosis was 4% (n = 2); the incidence of seroma was 4% (n = 2). We had to remove the implants in two cases. Natural and symmetrical breasts with good form, ptosis, and softness were achieved for most patients.

Conclusions

Good results were obtained with a high degree of esthetic and functional satisfaction for the majority of patients. A low rate of early complications compared to that reported in the international literature data was observed.

Level of Evidence: Level IV, therapeutic study

Keywords

Breast reconstruction ADM Muscle-sparing reconstruction Breast cancer 

Notes

Compliance with ethical standards

Conflict of interest

Marco Gardani, Francesco Simonacci, Giuseppina De Sario, Francesca Cattadori, Edoardo Raposio, and Dante Palli declare that they have no conflict of interest.

Ethical approval

For this kind of retrospective study formal consent from a local ethics committee is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Sources of funding

None.

References

  1. 1.
    Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A (2015) Global cancer statistics, 2012. Cancer J Clin 65:87–108CrossRefGoogle Scholar
  2. 2.
    Berne G, Cawthorn SJ, Padia 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 87:493–498CrossRefGoogle Scholar
  3. 3.
    Rozen WM, Rajkomar AK, Anavekar NS, Ashton MW (2009) Post-mastectomy breast reconstruction: a history in evolution. Clin Breast Cancer 9:145–154CrossRefGoogle Scholar
  4. 4.
    Salgarello M, Farallo E (2005) Immediate breast reconstruction with definitive anatomical implants after skin-sparing mastectomy. Br J Plast Surg 58:216–222CrossRefGoogle Scholar
  5. 5.
    Fernández-Delgado J, López-Pedraza MJ, Blasco JA et al (2008) Satisfaction with and psychological impact of immediate and deferred breast reconstruction. Ann Oncol 19:1430–1434CrossRefGoogle Scholar
  6. 6.
    Zienowicz RJ, Karacaoglu E (2007) Implant-based breast reconstruction with allograft. Plast Reconstr Surg 120:373–381CrossRefGoogle Scholar
  7. 7.
    Salzberg CA (2006) Nonexpansive immediate breast reconstruction using human acellular tissue matrix graft (AlloDerm). Ann Plast Surg 57:1–5CrossRefGoogle Scholar
  8. 8.
    Salzberg CA (2012) Direct-to-implant breast reconstruction. Clin Plast Surg 39:119–126CrossRefGoogle Scholar
  9. 9.
    Salzberg CA, Ashikari AY, Koch RM, Chabner-Thompson E (2011) An 8-year experience of direct-to-implant immediate breast reconstruction using human acellular dermal matrix (AlloDerm). Plast Reconstr Surg 127:514–524Google Scholar
  10. 10.
    Sbitany H, Sandeen SN, Amalfi AN, Davenport MS, Langstein HN (2009) Acellular dermis-assisted prosthetic breast reconstruction versus complete submuscular coverage: a head-to-head comparison of outcomes. Plast Reconstr Surg 124:1735–1740CrossRefGoogle Scholar
  11. 11.
    Johnson RK, Wright CK, Gandhi A, Charny MC, Barr L (2013) Cost minimisation analysis of using acellular dermal matrix (Strattice™) for breast reconstruction compared with standard techniques. Eur J Surg Oncol 39:242–247CrossRefGoogle Scholar
  12. 12.
    Nahabedian MY (2012) Acellular dermal matrices in primary breast reconstruction: principles, concepts, and indications. Plast Reconstr Surg 130:44S–53SCrossRefGoogle Scholar
  13. 13.
    Malata CM, McIntosh SA, Purushotham AD (2000) Immediate breast reconstruction after mastectomy for cancer. Br J Surg 87:1455–1472CrossRefGoogle Scholar
  14. 14.
    Galimberti V, Vicini E, Corso G, Morigi C, Fontana S, Sacchini V, Veronesi P (2017) Nipple-sparing and skin-sparing mastectomy: review of aims, oncological safety and contraindications. Breast 34:82–84CrossRefGoogle Scholar
  15. 15.
    NCCN. NCCN clinical practice guidelines in oncology: breast cancer, version 1.2016.2016Google Scholar
  16. 16.
    Kiernan T, Martin L (2013) Use of acellular dermal matrix is comparable to expander based breast reconstructions for post-operative physiotherapy requirements. Surgery Curr Res 3:136–137Google Scholar
  17. 17.
    McCarthy CM, Lee CN, Halvorson EG et al (2012) The use of acellular dermal matrices in two-stage expander/implant reconstruction: a multicenter, blinded, randomized controlled trial. Plast Reconstr Surg 130:57S–66SCrossRefGoogle Scholar
  18. 18.
    Tuan TL, Keller LC, Sun Q, Nimni ME, Cheung D (1994) Dermal fibroblasts on collagen gels activate keratinocyte outgrowth. J Cell Sci 107:2285–2289Google Scholar
  19. 19.
    Walter RJ, Matsuda T, Reyes HM et al (1998) Characterization of acellular dermal matrices (ADMs) prepared by two different methods. Burns 24:104–113CrossRefGoogle Scholar
  20. 20.
    Sasaki GG, Pang CY (1980) Haemodynamics and viability of acute neurovascular island skin flaps in rats. Plast Reconstr Surg 65:152–158CrossRefGoogle Scholar
  21. 21.
    Krejci NC, Cuono CB, Langdon RC, McGuire J (1991) In vitro reconstitution of skin: fibroblasts facilitate keratinocyte growth and differentiation on acellular reticular dermis. J Invest Dermatol. 97:843–848CrossRefGoogle Scholar
  22. 22.
    Lamme EN, van Leeuwen RTJ, Jonker A, Marle JV, Middelkoop E (1998) Living skin substitutes: survival and function of fibroblasts seeded in a dermal substitute in experimental wounds. J Invest Dermatol 111:989–995CrossRefGoogle Scholar
  23. 23.
    Özdogan M, Yilmaz KB, Özaslan C, Gürer A, Gülbahar O, Ersoy E (2008) Scalpel versus electrocautery dissections: the effect on wound complications and pro-inflammatory cytokine levels in wound fluid. Turk J Med Sci 38:111–116Google Scholar
  24. 24.
    Yilmaz KB, Dogan L, Nalbant H, Akinci M, Karaman N, Ozaslan C, Kulacoglu H (2011) Comparing scalpel, electrocautery and ultrasonic dissector effects: the impact on wound complications and pro-inflammatory cytokine levels in wound fluid from mastectomy patients. J Breast Cancer 14:58–63CrossRefGoogle Scholar
  25. 25.
    Burks RI (1998) Povidone-iodine solution in wound treatment. Phys Ther 78:212–218CrossRefGoogle Scholar
  26. 26.
    Van den Broek PJ, Buys LF, Van Furth R (1982) Interaction of povidone-iodine compounds, phagocytic cells, and microorganisms. Antimicrob Agents Chemother 22:593–597CrossRefGoogle Scholar
  27. 27.
    Adams WP Jr, Conner WC, Barton FE Jr, Rohrich RJ (2000) Optimizing breast pocket irrigation: an in vitro study and clinical implications. Plast Reconstr Surg 105:334–338CrossRefGoogle Scholar
  28. 28.
    Sbitany H, Serletti JM (2011) Acellular dermis-assisted prosthetic breast reconstruction: a systematic and critical review of efficacy and associated morbidity. Plast Reconstr Surg 128:1162–1169CrossRefGoogle Scholar
  29. 29.
    Nahabedian MY, Mesbahi AN (2009) Breast reconstruction with tissue expanders and implants. In: Nahabedian MY (ed) Cosmetic and reconstructive breast surgery. Elsevier, London, pp 1–20Google Scholar
  30. 30.
    Spear SL, Pelletiere CV, Lockwood M (2006) Immediate breast reconstruction with tissue expanders and AlloDerm. In: Spear SL, Wiley SC, Robb GL, Hammond DC, Nahabedian MY (eds) Surgery of the breast: principles and art. Lippincott Williams & Wilkins, Philadelphia, pp 484–488Google Scholar
  31. 31.
    Spear SL (2009) Acellular dermis-assisted prosthetic breast reconstruction versus complete submuscular coverage: a head-to-head comparison of outcomes (discussion). Plast Reconstr Surg 124:1741–1742CrossRefGoogle Scholar
  32. 32.
    Basu CB, Leong M, Hicks MJ (2010) Acellular cadaveric dermis decreases the inflammatory response in capsule formation in reconstructive breast surgery. Plast Reconstr Surg 126:1842–1847CrossRefGoogle Scholar
  33. 33.
    Sbitany H (2010) Techniques to reduce seroma and infection in acellular dermis-assisted prosthetic breast reconstruction. Plast Reconstr Surg 126:1121–1122CrossRefGoogle Scholar
  34. 34.
    Downs RK, Hedges K (2016) An alternative technique for immediate direct-to-implant breast reconstruction—a case series. Plast Reconstr Surg Glob Open 4:e821CrossRefGoogle Scholar
  35. 35.
    Berna G, Cawthorn SJ, Papaccio G, Balestrieri N (2017) Evaluation of a novel breast reconstruction technique using the Braxon® acellular dermal matrix: a new muscle-sparing breast reconstruction. ANZ J Surg 87:493–498CrossRefGoogle Scholar
  36. 36.
    Vidya R, Masià J, Cawthorn S, Berna G, Bozza F, Gardetto A, Kołacińska A, Dell'Antonia F, Tiengo C, Bassetto F, Caputo GG, Governa M (2017) Evaluation of the effectiveness of the prepectoral breast reconstruction with Braxon dermal matrix: first multicenter European report on 100 cases. Breast J 23:670–676CrossRefGoogle Scholar
  37. 37.
    Salzberg CA, Ashikari AY, Berry C, Hunsicker LM (2016) Acellular dermal matrix-assisted direct-to-implant breast reconstruction and capsular contracture: a 13-year experience. Plast Reconstr Surg 138:329–337CrossRefGoogle Scholar
  38. 38.
    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 66:1382–1389CrossRefGoogle Scholar
  39. 39.
    Cheng A, Lakhiani C, Saint-Cyr M (2013) Treatment of capsular contracture using complete implant coverage by acellular dermal matrix: a novel technique. Plast Reconstr Surg 132:519–529CrossRefGoogle Scholar
  40. 40.
    Berna G, Cawthorn SJ (2017) Long term follow-up on prepectoral ADM-assisted breast reconstruction: evidences after 4 years. Eur J Plast Surg 40:255–258CrossRefGoogle Scholar
  41. 41.
    Jafferbhoy S, Chandarana M, Houlihan M, et al. (2017). Early multicentre experience of pre-pectoral implant based immediate breast reconstruction using Braxon®. Gland Surg  https://doi.org/10.21037/gs.2017.07.07
  42. 42.
    Simonacci F, Grieco MP, Bertozzi N, Raposio E (2017) Autologous fat transplantation for secondary breast reconstruction: our experience. G Chir 38:117–123CrossRefGoogle Scholar
  43. 43.
    Simonacci F, Bertozzi N, Grieco MP, Grignaffini E, Raposio E (2017) Procedure, applications, and outcomes of autologous fat grafting. Ann Med Surg 20:49–60CrossRefGoogle Scholar
  44. 44.
    Simonacci F, Bertozzi N, Grieco MP, Grignaffini E, Raposio E (2016) Autologous fat transplantation for breast reconstruction: a literature review. Ann Med Surg (Lond) 12:94–100CrossRefGoogle Scholar
  45. 45.
    Gardani M, Bertozzi N, Grieco MP, Pesce M, Simonacci F, Santi P, Raposio E (2017) Breast reconstruction with anatomical implants: a review of indications and techniques based on current literature. Ann Med Surg (Lond) 21:96–104CrossRefGoogle Scholar
  46. 46.
    Bertozzi N, Pesce M, Santi PL, Raposio E (2017) Oncoplastic breast surgery: comprehensive review. Eur Rev Med Pharmacol Sci 21:2572–2585Google Scholar
  47. 47.
    Raposio E, Belgrano V, Santi P, Chiorri C (2016) Which is the ideal breast size?: some social clues for plastic surgeons. Ann Plast Surg 76:340–345CrossRefGoogle Scholar
  48. 48.
    Raposio E, Cicchetti S, Adami M, Ciliberti RG, Santi PL (2004) Computer planning for breast reconstruction by tissue expansion: an update. Plast Reconstr Surg 113:2095–2097CrossRefGoogle Scholar
  49. 49.
    Bertozzi N, Pesce M, Santi P, Raposio E (2017) Tissue expansion for breast reconstruction: methods and techniques. Ann Med Surg (Lond) 21:34–44CrossRefGoogle Scholar
  50. 50.
    Del Vecchio D, Rohrich RJ (2012) A classification of clinical fat grafting: different problems, different solutions. Plast Reconstr Surg 130:511–522CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Breast Unit, Department of General SurgeryGuglielmo da Saliceto HospitalPiacenzaItaly
  2. 2.Plastic Surgery Division, Department of Medicine and SurgeryUniversity of ParmaParmaItaly
  3. 3.The Cutaneous, Mininvasive, Regenerative, and Plastic Surgery UnitParma University HospitalParmaItaly

Personalised recommendations