Background
Implant based reconstruction is the most common type of breast reconstruction post mastectomy. The use of acellular dermal matrix (ADM) as an inferolateral hammock to cover and support the inferior pole of the implant has many advantages. The practice of using ADM in breast reconstruction has gained momentum internationally for several years, however has only recently become easily available in Australia with the introduction of Flex HD (a human ADM allograft). We present a single surgeon’s experience using Flex HD for immediate breast reconstruction (IBR) compared to traditional complete sub-muscular reconstruction, to our knowledge the first Australian series.
Method
A retrospective review of the first fifty IBR using Flex HD compared to fifty consecutive sub-muscular IBR without ADM during the period of February 2014 to March 2016. Patients undergoing delayed reconstruction, wise-pattern mastectomy, or with a BMI >32 were excluded from the comparison group. Patient demographics, adjuvant treatment, length of expansion, cosmesis and complications were analysed.
Results
Thirty-four patients underwent fifty IBR using Flex HD, with fifteen single stage direct to implant reconstructions (DTI). Thirty-six patients who underwent fifty immediate sub-muscular reconstructions formed the comparison group. The patient characteristics were comparable in terms of age, body-mass-index and diabetes. The use of ADM allowed higher intraoperative fills with an average of 62% of total expander volume filled achieved compared to 50% in the sub-muscular group. Fourteen patients in the ADM group experienced a complication (infection, seroma, haematoma, implant loss), compared to 16 in the sub-muscular group (p=0.66).
Conclusions
The use of ADM as an adjunct to implant based reconstruction allows higher initial expander fill volumes and the potential for one-staged DTI reconstructions providing potential cost saving benefits. The ability to precisely define the infra-mammary fold and increase lower pole expansion results in improved cosmetic outcomes without increase in complication rates.