Delayed prosthetic breast reconstruction without the use of acellular dermal matrix

Since the widespread adoption of acellular dermal matrices (ADM) in immediate breast reconstruction, many surgeons have applied the same techniques to delayed reconstruction. To counteract this trend, we present a method of performing delayed prosthetic breast reconstruction without the use of ADM. This approach produces excellent aesthetic outcomes while eliminating the cost of relatively expensive ADM.

A retrospective review was performed on patients who underwent delayed implant-based breast reconstruction without ADM at a single institution between 2001 and 2013.

A total of 31 patients met inclusion criteria. In our cohort, radiation therapy was performed on 14 patients (45%). Expanders were filled intraoperatively to a median volume of 150 cm³, and median permanent implant size was 500 cm³. Operative time averaged 62 minutes for unilateral expander insertion and 92 minutes for bilateral insertion. After expander placement, complications requiring reoperation occurred in five patients (16%), of which four (75%) had prior radiation therapy. Permanent implants were placed in 29 patients (94%), and six of these patients (21%) underwent additional procedures. Thirteen patients without prior radiation (76%) and eight patients with prior radiation (57%) did not undergo any unplanned surgical interventions during the reconstructive process.

Our study shows delayed breast reconstruction can be successfully performed without ADM. Since delayed reconstruction is generally performed less frequently than immediate reconstruction, plastic surgeons are advised to critically review their techniques, as the operation should be approached differently. While ADM may have specific benefits in immediate reconstruction, those benefits do not directly translate in delayed reconstruction.

Level of Evidence: Level IV, risk/ prognostic study.