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The First Use of Human-Derived ADM in Prepectoral Direct-to-Implant Breast Reconstruction after Skin-Reducing Mastectomy

  • Original Article
  • Breast Surgery
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Abstract

Introduction

Large and ptotic breasts always represented a great reconstructive challenge for plastic surgeons. In order to deal with these patients, we started performing Wise-pattern skin-reducing mastectomies (SRM) followed by direct-to-implant breast reconstructions (DTI-BR) in the prepectoral space where the implants were covered with the autologous adipo-dermal flap and a human acellular dermal matrix called MODA.

Materials and Method

We retrospectively reviewed all patients that underwent Wise-pattern SRM followed by MODA-assisted, prepectoral, DTI-BR between January 2017 and November 2019 at our Institution. Inclusion criteria were large ptotic breast and pinch test >2cm, while exclusion criteria were smoking >10 cigarettes/day, history of prior radiotherapy, patients supposedly requiring breast implants bigger than 550cc or post-mastectomy radiotherapy. Patients’ data were collected through their electronic medical records. Both short- and long-term outcomes were reported.

Results

Seventeen patients underwent Wise-pattern SRM followed by MODA-assisted, prepectoral, DTI-BR for a total of twenty-one breast reconstruction and fourteen matching procedures. Mean follow-up was 13.4 months (SD= ±3.67). No major complication was reported. Three (14.3%) reconstructed breasts had minor complications: 2 (9.5%) minimal (<1cm2) wound dehiscence and 1 (4.8%) de-epithelization of the skin at the T junction that were treated conservatively. Drainages gave mean output of 410.59 ml (SD= ±214.83) and were kept in place on average for 8.59 days (SD= ±3.45).

Conclusion

Few are the reports in the literature regarding DTI-BR following SRM and even fewer are those where BR was performed in the prepectoral space. Our work demonstrated the safety of prepectoral DTI-BR following SRM in selected patients in accordance with the “conservative reconstruction” principles. Furthermore, we confirmed the reliability of MODA in accordance with previously published works.

Level of Evidence IV

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Funding

The authors received no financial support for the research, authorship and/or publication of this article. None of the author has financial interest to declare in relation to the content of this article.

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  1. Breast Surgery Unit, Morgagni-Pierantoni Hospital, Ausl Romagna, Via Carlo Forlanini 34, 47100, Forli, Italy

    Francesco Marongiu, Nicolò Bertozzi, Andrea Sibilio, Daniela Tognali, Matteo Mingozzi & Annalisa Curcio

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  1. Francesco Marongiu
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  2. Nicolò Bertozzi
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Correspondence to Nicolò Bertozzi.

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Marongiu, F., Bertozzi, N., Sibilio, A. et al. The First Use of Human-Derived ADM in Prepectoral Direct-to-Implant Breast Reconstruction after Skin-Reducing Mastectomy. Aesth Plast Surg 45, 2048–2057 (2021). https://doi.org/10.1007/s00266-021-02231-5

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