Document Detail

Acellular dermis-assisted prosthetic breast reconstruction versus complete submuscular coverage: a head-to-head comparison of outcomes.
MedLine Citation:
PMID:  19952627     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Complete submuscular tissue expander coverage affords the best protection against implant exposure but restricts lower pole expansion. Techniques using acellular dermis as a pectoralis muscle extension can allow for more rapid fill of the expander and better control of the inframammary fold. This study compares both techniques with regard to relevant outcomes.
METHODS: Results of 100 consecutive breast expander reconstructions performed by two surgeons between 2004 and 2007 were retrospectively reviewed. Patient demographics, expander coverage type, adjuvant treatment, length and characteristics of the expansion, and incidence and types of complications were analyzed.
RESULTS: One hundred women underwent breast reconstruction with 172 expanders, in 50 using complete submuscular placement and in 50 using partial subpectoral placement with acellular dermis. The patient groups were similar in terms of demographic data. Mean number of fills to complete reconstruction was 4.31 in the submuscular group and 1.72 in the acellular dermis group (p = 0.0001). Mean intraoperative fill volume was 130 cc in the submuscular group, compared with 412 cc per expander in the acellular dermis group (p = 0.0001). Fisher's exact test demonstrated no significant difference in total complication rate between the two groups (14 percent versus 18 percent; p = 0.79).
CONCLUSIONS: Acellular dermis allowed for a greater initial fill of saline. This potentially improves cosmetic outcome, as it better capitalizes on preserved mastectomy skin for reconstruction. The authors conclude that acellular dermis-assisted implant breast reconstruction has a safety profile no worse than that of complete submuscular coverage but offers the benefit of fewer expansions and the potential for more predictable secondary revisions.
Hani Sbitany; Sven N Sandeen; Ashley N Amalfi; Mark S Davenport; Howard N Langstein
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Plastic and reconstructive surgery     Volume:  124     ISSN:  1529-4242     ISO Abbreviation:  Plast. Reconstr. Surg.     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-12-02     Completed Date:  2010-01-11     Revised Date:  2014-10-13    
Medline Journal Info:
Nlm Unique ID:  1306050     Medline TA:  Plast Reconstr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1735-40     Citation Subset:  AIM; IM    
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MeSH Terms
Breast Implants
Breast Neoplasms / pathology,  surgery
Cohort Studies
Graft Rejection
Graft Survival
Mammaplasty / methods*
Mastectomy / methods
Middle Aged
Pectoralis Muscles / transplantation
Retrospective Studies
Risk Assessment
Skin Transplantation / methods
Skin, Artificial*
Surgical Flaps*
Treatment Outcome
Wound Healing / physiology
Comment In:
Plast Reconstr Surg. 2009 Dec;124(6):1741-2   [PMID:  19952628 ]
Plast Reconstr Surg. 2010 Aug;126(2):672-3; author reply 673-4   [PMID:  20679855 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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