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Acellular dermal matrix fenestrations and their effect on breast shape

Abstract

Background

Acellular dermal matrices (ADMs) are increasingly being utilized in primary and secondary breast reconstruction as they confer several advantages, including soft tissue enhancement at the inferolateral pole of the breast. The senior authors have added fenestrations to ADMs to allow for more rapid expansion and improved breast aesthetics. The purpose of this study is to describe the benefits of ADM fenestration using a mathematical formula as a proof of concept for the effects of these modifications on breast shape.

Methods

The aggregate effect of symmetrically arranged fenestrations on the ADM’s mechanical properties is explained by a uniform reduction in the effective Young’s modulus of the graft in a direction perpendicular to the chest wall in the area of graft fenestration. Asymmetric reduction of the Young’s modulus is achieved by concentration of the fenestrations at either the cephalic or caudal ends of the ADM.

Results

The relaxed Young’s modulus facilitates an increased deflection of the ADM from its resting, unaltered state under the weight of the implant or tissue expander and is modeled using a one-dimensional boundary equation. The reduced inferior pole tension allows for enhanced expansion under the weight of the implant or tissue expander. The effects of asymmetrically arranged fenestrations are similarly modeled and appear to afford the surgeon greater precision in controlling inferior pole characteristics.

Conclusions

Acellular dermal matrix fenestration improves aesthetic outcome by facilitating greater inferior pole expansion. Mathematical models are provided to describe the modifications and elucidate the mechanism behind their effect on breast shape.

Level of Evidence: Not ratable

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Funding

This study was not supported by any sources of funding.

Conflict of interest

Authors Garrett A. Wirth, Donald S. Mowlds, Patrick Guidotti, Ara A. Salibian, Audrey Nguyen, and Keyianoosh Z. Paydar declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study (retrospective), formal consent is not required.

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Correspondence to Garrett A. Wirth.

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Wirth, G.A., Mowlds, D.S., Guidotti, P. et al. Acellular dermal matrix fenestrations and their effect on breast shape. Eur J Plast Surg 38, 267–272 (2015). https://doi.org/10.1007/s00238-015-1090-5

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Keywords

  • Acellular dermal matrix
  • Breast reconstruction
  • Fenestrations
  • Inferior pole expansion
  • Mathematical model