Implant based procedures remain a popular choice in immediate breast reconstruction. The addition of an acellular dermal matrix (ADM), sutured to create an inferolateral sling, improves aesthetic outcomes and ensures complete coverage of the implant device without the potential complications of a donor site. The purpose of this study was to evaluate a single unit’s experience of ADM in immediate implant based breast reconstruction.
Methods/Technique:
Data was collected prospectively for all patients undergoing an immediate implant/expander and ADM reconstruction and analysed over 2 periods, December 2008 to January 2010 and February to July 2012. In all cases a reconstructive tissue matrix derived from porcine dermis (Strattice™, LifeCell) was used.
Results/Complications:
ADM was used in 82 patients (87 breasts), 20 patients (22 breasts) in the first period and 62 (65 breasts) in the second. In period 1, there was a 45% major complication rate, mainly requiring return to theatre, and an overall explantation rate of 23%. Following these observations a number of technical refinements were made reducing the return to theatre rate to 8% and explantation to 0% in the second period therefore improving aesthetic and reconstructive outcomes.
Conclusion:
This study shows that ADM is a safe and effective means of covering and controlling the position of the implant/expander in immediate breast reconstruction when used correctly, providing the patient with a good aesthetic result. Our results show that there is learning curve with this technique, nonetheless ADM is a useful option available for immediate breast reconstruction.