Pre-Pectoral Tissue Expander and Acellular Dermal Matrix for a Two-Stage Muscle Sparing Breast Reconstruction: Indications, Surgical Technique and Clinical Outcomes with Histological and Ultrasound Follow-Up-A Population-Based Cohort Study.

[BACKGROUND] The aim of the paper is to present a single-center experience with two-stage pre-pectoral breast reconstruction using tissue expander entirely covered by acellular dermal matrix (ADM), reporting surgical indications, technique, clinical and histological outcomes.

[MATERIALS AND METHODS] A prospectively maintained database of consecutive patients who had undergone immediate pre-pectoral expander-based breast reconstruction with ADM over a two years period (2019-2021) was analyzed. The primary clinical outcome measures included patients' subjective assessment of satisfaction and pain. Secondary outcomes were complication rates, the frequency of readmissions and incidence of capsular contracture. All patients underwent ultrasound examination 3 weeks postoperatively and at the end of tissue expansion completion. Histological examination of the periprosthetic tissue was performed during the second stage of the reconstructive procedure.

[RESULTS] A total of 46 patients with a mean age of 46.5 years (range: 24-62) underwent collectively 54 breast reconstructions with a mean follow-up of 22.5 months after definitive implant placement. The time to reach the final volume was on average 47.2 days (range 40-58). Complications occurred in 14 (25.9%) breast reconstructions: 11 (20.4%) seromas, 2 (3.7%) infections, 1 (1.8%) flap necroses, 2(3.7%) expander removals. Overall scores for Satisfaction were all significantly increased after surgery. Histological examination revealed complete ADM integration in the host tissue, with thinner, less sclerotic tissue compared to the submuscular capsular samples.

[CONCLUSIONS] Tissue expander-ADM-based breast reconstruction can be safely used in selected cases for two-stage pre-pectoral breast reconstructions and can result in significant pain-relief procedure with optimal aesthetical outcomes.

[LEVEL OF EVIDENCE IV] This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .