4 research outputs found
Combination of acellular dermal matrix with a de-epithelialised dermal flap during skin-reducing mastectomy and immediate breast reconstruction
INTRODUCTION: Patients with large ptotic breasts undergoing immediate implant-based reconstruction often require skin-reducing
mastectomy to optimise the aesthetic outcome. However, healing complications, especially at the resulting inverted T-junction,
leading to wound dehiscence, infection, skin necrosis, implant exposure and failed reconstruction have been widely
reported. We present an innovative approach for immediate implant-based reconstruction combining porcine- or bovine-derived
acellular dermal matrices with a de-epithelialised dermal sling to protect and support the implant, while improving clinical outcomes
in this challenging group of patients.
MATERIALS AND METHODS: Demographic, tumour and surgical data were reviewed for patients undergoing Wise pattern (T-scar)
skin-reducing mastectomies with immediate implant-based reconstruction combining porcine- or bovine-derived acellular dermal
matrices with a de-epithelialised dermal sling.
RESULTS: This technique was successfully employed to reconstruct five large pendulous breasts in four breast cancer patients
with a median age of 50.5 years (range 34â61 years) who were not suitable for, or had declined, flap-based reconstruction.
The acellular dermal matrices used were SurgiMendÂŽ, StratticeTM and BraxonÂŽ and the expandable implants were placed in
the sub-pectoral (n = 3) and pre-pectoral (n = 1) planes. The technical steps and clinical outcomes are presented. One patient
experienced T-junction breakdown overlying the de-epithelialised dermis without implant loss.
CONCLUSION: The combination of an acellular dermal matrix and a dermal sling provides a double-layer âwater-proofingâ and
support for the implants inferiorly, avoiding T-junction breakdown complications, since any dehiscence is on to well-vascularised
dermis. Furthermore, the acellular dermal matrix stabilises the implant in the large mastectomy cavity (pocket control).
This approach provides a viable option which facilitates mastectomy and immediate implant reconstruction in large-breasted
patients