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Prepectoral Tissue Expander Placement for Breast Reconstruction Using Meshed Acellular Dermal Matrix--An Institutional Experience

Willis, Rhett N MD; Moores, Neal MD; Kwok, Alvin MD, MPH; Agarwal, Jayant MD

Plastic and Reconstructive Surgery – Global Open: July 2019 - Volume 7 - Issue 7S - p 3
doi: 10.1097/01.GOX.0000579800.41325.7f
Mountain West 2019 Abstract Supplement
Open

University of Utah, Salt Lake City, UT

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

INTRODUCTION: Prepectoral tissue expansion is made possible with the use of acellular dermal matrix (ADM). Prepectoral reconstruction eliminates the risk of animation deformities, decreases operative time, and minimizes postoperative pain. Compared with subpectoral reconstruction, prepectoral reconstruction requires larger amounts of ADM thus adding to the cost of the procedure. We present a novel approach of using a single 6x16 cm meshed sheet of ADM to anteriorly cover tissue expanders (TE) for prepectoral breast reconstruction.

METHODS: In 2018, 7 patients underwent prepectoral tissue expander placement with a single 6x16 cm sheet of ADM (Alloderm RTU, LifeCell Corp) meshed to a 1:1.5 ratio. Patient selection was based on preoperative patient goals and intraoperative flap assessment. Size of TE used ranged from a base diameter of 11–13 cm.

RESULTS: Of the 7 meshed reconstructions, no patients had postoperative complications of seroma, infection, or TE explantation. One patient has made it to implant exchange with satisfactory results. Our institutional prices range from $2,830 for a 6x16 cm sheet of ADM to $9,431 for a 16x20 cm sheet of ADM. Using the meshed technique results in significant cost reductions: $6,601 for unilateral and $13,202 for bilateral reconstruction.

CONCLUSIONS: A meshed 6x16 cm sheet of ADM allows for adequate anterior coverage of a prepectoral tissue expander with a base diameter of 13cm or less. We advocate that meshed prepectoral allograft placement is a safe and cost effective alternative to nonmeshed ADM in a select patient population.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.