Henry Ford Hospital, Detroit, Michigan

 Immediate direct to implant (DTI) prepectoral reconstruction has increasingly popular due to1,2:

Improved aesthetic outcomes 

Improved  psychological well-being

Decreased animation deformity

Improved physical functioning

Decreased recovery time

 

Historically immediate DTI has been associated with higher rates of:

Seroma, infection, contracture, and explantation1,2

Immediate DTI, specifically prepectoral, requires use of acellular dermal matrix (ADM)

To provide a safer approach to DTI, we evaluated the complication profile associated with the different types of dermal matrices and surgical meshes available for use in immediate DTI reconstruction.

A retrospective cohort study of patients undergoing immediate DTI reconstruction in either the prepectoral or subpectoral plane from 2019-2022 at a large metropolitan healthcare system was performed

Data extracted included:

Demographics, comorbidities, procedural details, cancer treatments received, and major and minor complications

Univariate and multivariate analyses

2 patients (402 breasts) underwent prepectoral (n = 188) or subpectoral (n = 54) direct to implant reconstruction 

Univariate analyses of complications between the matrices used demonstrated: 

AlloDerm use resulted in a statistically significant higher incidence of:

Cellulitis (p = 0.037)

Capsular contracture (p = 0.008)

Implant exchange for capsular contracture (p = 0.004)

Seroma requiring drainage (p = 0.008) 

No significant differences in demographics, diabetes, smoking, implant type or size, mastectomy type, neoadjuvant or adjuvant chemotherapy, radiation therapy, or axillary lymph node dissection.

No significant difference in rates of cellulitis, explantation for infection, hematoma or seroma requiring drainage, and skin necrosis

Multivariate analysis demonstrated that patients reconstructed with FlexHD demonstrated:

Decreased risk of capsular contracture 

Decreased rate of reoperation for capsular contracture

No statistically significant difference in the rates of cellulitis or seroma on multivariate analysis

No significant difference in postoperative complication rates between autologous dermal flaps and matrices

Certain products have improved safety profiles which should be considered during operative planning