Acellular dermal matrix in breast reconstruction surgery. First experience in Ukraine

Authors

  • A.V. Zhygulin LISOD Hospital of Israeli oncology, Kyiv, Ukraine,
  • A.E. Fedosov LISOD Hospital of Israeli oncology, Kyiv, Ukraine,
  • V.Ya. Palytsia LISOD Hospital of Israeli oncology, Kyiv, Ukraine,
  • V.S. Nedielchev LISOD Hospital of Israeli oncology, Kyiv, Ukraine,
  • D.K. Vinnytska LISOD Hospital of Israeli oncology, Kyiv, Ukraine,
  • Zvi Bernstein LISOD Hospital of Israeli oncology, Kyiv, Ukraine,

DOI:

https://doi.org/10.22141/2663-3272.3.1.2020.209820

Keywords:

Background. Breast reconstruction after mastectomy is an important factor affecting patient’s quality of life. Mechanical and biological features of acellular dermal matrix (ADM) allows simplifying the breast reconstruction and achieving better functional and aesthetic results, especially for women

Abstract

Background. Breast reconstruction after mastectomy is an important factor affecting patient’s quality of life. Mechanical and biological features of acellular dermal matrix (ADM) allows simplifying the breast reconstruction and achieving better functional and aesthetic results, especially for women with medium and large breast size. Objective: to present the first experience of breast reconstruction with ADM in Ukraine with the analysis of the technical aspects of surgeries, early and delayed surgical, oncological and functional results. Materials and methods. This work is the retrospective analysis of implant-based breast reconstruction with ADM in the Breast Unit of LISOD Hospital of Israeli Oncology. Results. Thirty-five operations were performed for 27 patients, 34 of them were immediate and one — delayed reconstruction. The average age of women was 44 (30–71) years. Therapeutic procedures were performed in 25 (73.5 %) cases, prophylactic — in 4 (11.8 %), symmetrised — in 5 (14.7 %). Eighteen (52.9 %) mastectomies were nipple-sparing. The average time of follow-up was 46 (6–84) months. Early complications such as ischemia and skin necrosis, infection, hematoma were detected in 11 (31.4 %) cases. Late complications such as infections and late seromas were observed in 4 (11.4 %) cases. Five (14.3 %) revisions were performed, 3 (8.6 %) implants were lost. Grade 3 capsular contracture was found in 5 (14.3 %) reconstructed breasts. Systemic recurrence occurred in 6 patients, 5 of them died. We had performed a survey about aesthetic and functional results in 21 (77.8 %) patients: 19 (90.5 %) were very satisfied and 2 (9.5 %) — were rather satisfied. No patients were unsatisfied. Conclusions. Despite the certain complications rate, the mechanical and biological features of ADM allow us to make an effective breast reconstruction even in patients with medium and large breasts. It provides for the further lipografting, and promotes good aesthetic and functional results after breast reconstruction.

References

Федоренко З.П., Гулак Л.О., Михайлович Ю.Й. та ін. Рак в Україні (2018–2019). Захворюваність, смертність, показники діяльності онкологічної служби. Бюлетень Національного канцер-реєстру України № 21. Київ, 2020. http://www.ncru.inf.ua/publications/BULL_21/index.htm

Bray F., Ferlay J., Soerjomataram I. et al. Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries CA. Cancer. J. Clin. 2018. 68. 394-424. DOI: 10.3322/caac.21492.

NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines). Breast Cancer. Version 3. 2020 March 6. https://www.nccn.org/

Cardoso F., Kyriakides І., Ohno S. et al. Early Breast Cancer: ESMO Clinical Practice Guidelines for Diagnosis, Treatment and Follow-Up. Ann. Oncol. 2019. 30. 1194-1220. DOI: 10.1093/annonc/mdz189.

Уніфікований клінічний протокол первинної, вторинної (спеціалізованої), третинної (високоспеціалізованої) медичної допомоги «Рак молочної залози». Наказ МОЗ України від 30 червня 2015 р. № 396. http://www.dec.gov.ua/mtd/reestr.html

Panchal H., Matros E. Current Trends in Post-Mastectomy Breast Reconstruction. Plast. Reconstr. Surg. 2017 Nov. 140(5). 7S-13S. DOI: 10.1097/PRS.0000000000003941.

Cronin T.D., Gerow F.J. Augmentation mammaplasty: a new “natural feel” prosthesis. Amsterdam: In: Transactions of the Third International Congress of Plastic and Reconstructive Surgery. Excerpta Medica. 1963.

Freeman B.S. Subcutaneous mastectomy for benign breast lesions with immediate or delayed prosthetic replacement. Plast. Reconstr. Surg. Transplant. Bull. 1962 Dec. 30. 676-82. DOI: 10.1097/00006534-196212000-00008.

Snyderman R.K., Guthrie R.H. Reconstruction of the female breast following radical mastectomy. Plast. Reconstr. Surg. 1971. 47. 565-567. DOI: 10.1097/00006534-197106000-00008.

Gruber R.P., Kahn R.A., Lash H. et al. Breast reconstruction following mastectomy: a comparison of submuscular and subcutaneous techniques. Plast. Reconstr. Surg. 1981. 67(3). 312-317.

Dempsey W.C., Lathern W.O. Subpectoral implants in augmentation mammoplasty. Plast. Reconstr. Surg. 1968. 42. 515.

Radovan C. Breast reconstruction after mastectomy using the temporary expander. Plast. Reconstr. Surg. 1982. 69. 195-208. DOI: 10.1097/00006534-198202000-00001.

Toth B.A., Lappert P. Modified skin incisions for mastectomy: The need for plastic surgical input in preoperative planning. Plast. Reconstr. Surg. 1991. 87. 1048. DOI: 10.1097/00006534-199106000-00006.

Boháč M., Danišovič Ľ., Koller J. et al. What happens to an acellular dermal matrix after implantation in the human body? A histological and electron microscopic study. European Journal of Histochemistry. 2018. 62. 2873. DOI: 10.4081/ejh.2018.2873.

American Society of Plastic Surgeons. Plastic surgery statistics report. 2012. Available at https://d2wirczt3b6wjm.cloudfront.net/News/Statistics/2012/plastic-surgery-statistics-full-report-2012.pdf

Mylvaganam S., Conroy E., Paula R. et al. Variation in the provision and practice of implant-based breast reconstruction in the UK: Results from the iBRA national practice questionnaire. Breast. 2017 Oct. 35. 182-190. doi: 10.1016/j.breast.2017.07.016.

Scheflan M., Maisel Lotan A., Allweis T.M. Trans-vertical mastectomy with immediate implant-based reconstruction: a retrospective, observational study. Aesthet. Surg. J. 2019. 39(7). 733-742. DOI: 10.1093/asj/sjy181.

Wainwright D.J. Use of an acellular allograft dermal matrix (AlloDerm) in the management of full-thickness burns. Burns. 1995. 21(4). 243-8. DOI: 10.1016/0305-4179(95)93866-i.

Breuing K.H., Warren S.M. Immediate bilateral breast reconstruction with implants and inferolateral AlloDerm slings. Ann. Plast. Surg. 2005. 55(3). 232-9. DOI: 10.1097/01.sap.0000168527.52472.3c.

Wong A.K., Schonmeyr B., Singh P. et al. Histologic analysis of angiogenesis and lymphangiogenesis in acellular human dermis. Plast. Reconstr. Surg. 2008. 121(4). 1144-52. doi.org/10.3389/fmed.2016.00072.

Garcia O.Jr., Scott J.R. Analysis of acellular dermal matrix integration and revascularization following tissue expander breast reconstruction in a clinically relevant large-animal model. Plast. Reconstr. Surg. 2013. 131(5). 741e-51e. DOI: 10.1097/PRS.0b013e3182865c6d.

Kim I.K., Park S.O., Chang H., Jin U.S. Inhibition Mechanism of Acellular Dermal Matrix on Capsule Formation in Expander-Implant Breast Reconstruction After Postmastectomy Radiotherapy. Ann. Surg. Oncol. 2018. 25(8). 2279-2287. DOI: 10.1245/s10434-018-6549-8.

Leong M., Basu C.B., Hicks M.J. Further evidence that human acellular dermal matrix decreases inflammatory markers of capsule formation in implant-based breast reconstruction. Aesthet. Surg. J. 2015. 35(1). 40-7. DOI: 10.1093/asj/sju014.

Scheflan M., Colwell A.S. Tissue Reinforcement in Implant-based Breast Reconstruction. Plast. Reconstr. Surg. Glob. Open. 2014. 2. e192; DOI: 10.1097/GOX.0000000000000140.

Cook L.J., Kovacs T. Novel devices for implant-based breast reconstruction: is the use of meshes to support the lower pole justified in terms of benefits? A review of the evidence. Ecancer. 2018. 12. 796. DOI: 10.3332/ecancer.2018.796.

Hallberg H., Rafnsdottir S., Selvaggi S. et al. Benefits and risks with acellular dermal matrix (ADM) and mesh support in immediate breast reconstruction: a systematic review and meta-ana­lysis. Journal of Plastic Surgery and Hand Surgery. 2018. DOI: 10.1080/2000656X.2017.1419141.

Nahabedian M.Y., Spear S.L. Acellular Dermal Matrix for Secondary Procedures Following Prosthetic Breast Reconstruction. Aesthetic. Surgery Journal. 2011. 31. 7 (suppl.). 38S-50S. DOI: 10.1177/1090820X11418093.

Maxwell G.P., Gabriel A. Bioengineered Breast: Concept, Technique, and Preliminary Results. Plast. Reconstr. Surg. 2016. 137(2). 415-21. DOI: 10.1097/01.prs.0000475750.40838.53.

Krishnan N.M., Chatterjee A., Rosenkranz K.M. et al. The cost effectiveness of acellular dermal matrix in expander-implant immediate breast reconstruction. J. Plast. Reconstr. Aesthet. Surg. 2014. 67(4). 468-76. DOI: 10.1016/j.bjps.2013.12.035.

Dikmans R.E., Negenborn V.L., Bouman M.B. et al. Two-stage implant-based breast reconstruction compared with immediate one-stage implant-based breast reconstruction augmented with an acellular dermal matrix: an open-label, phase 4, multicentre, randomised, controlled trial. Lancet Oncol. 2017. 18(2). 251-258. DOI: 10.1016/j.bjps.2017.05.001.

Kim J.Y.S., Mlodinow A.S. What’s New in Acellular Dermal Matrix and Soft-Tissue Support for Prosthetic Breast Reconstruction. Plast. Reconstr. Surg. 2017. 140. 30S. DOI: 10.1097/PRS.0000000000003950.

Aguilera-Sáez J., Roura P.B., Ferrer A.G. et al. Early complications in cases series in implant based immediat e breast reconstruct ion with a biological acellular matrix during the learning curve of this technique and using 3 different matrices: a case series of 84 breasts. International Journal of Surgery Oncology. 2018. 3. e52. DOI: 10.1097/IJ9.0000000000000052.

Heidemann L.N., Gunnarsson G.L., Salzberg C.A. et al. Сomplications following nipple-sparing mastectomy and immediate acellular dermal matrix Implant-based breast reconstruction — a systematic review and meta-analysis. Plast. Reconstr. Surg. Glob. Open. 2018. 6. e1625. DOI: 10.21037/gs.2017.08.06.

Logan E., Asaolu O., Nebo V., Kasem A. Biological and synthetic mesh use in breast reconstructive surgery: a literature review. World Journal of Surgical Oncology. 2016. 14. 121. DOI: 10.1186/s12957-016-0874-9.

Forsberg C.G., Kelly D.A., Wood B.C. et al. Aesthetic outcomes of acellular dermal matrix in tissue expander/implant-based breast reconstruction. Ann. Plast. Surg. 2014. 72(6). S116-20. DOI: 10.1097/SAP.0000000000000098.

Ibrahim A.M., Koolen P.G., Ganor O. et al. Does acellular dermal matrix really improve aesthetic outcome in tissue expander/implant-based breast reconstruction? Aesthetic. Plast. Surg. 2015. 39(3). 359-68. DOI: 10.1007/s00266-015-0484-x.

Ibrahim A.M., Ayeni O.A., Hughes K.B. et al. Acellular dermal matrices in breast surgery. A comprehensive review. Ann. Plast. Surg. 2013. 70. 732-738. DOI: 10.1097/SAP.0b013e31824b3d30.

Lohmander F., Lagergren J., Roy P.G. et al. Implant based breast reconstruction with acellular dermal matrix safety data from an open-label, multicenter, randomized, controlled trial in the setting of breast cancer treatment. Ann. Surg. 2018. DOI: 10.1097/SLA.0000000000003054.

Hillberg N.S., Ferdinandus P.I., Dikmans R.E.G. et al. Is single-stage implant-based breast reconstruction (SSBR) with an acellular matrix safe? Strattice™ or Meso Biomatrix® in SSBR. European Journal of Plastic Surgery. 2018. 41. 429-438. DOI: https://doi.org/10.1007/s00238-018-1415-2.

Cheng A., Saint-Cyr M. Comparison of Different ADM Materials in Breast Surgery. Clin. Plastic. Surg. 2012. 39. 167-175. DOI: 10.1097/GOX.0000000000001576.

Published

2020-02-01

Issue

Section

Original Researches