Biologic matrices in oncologic breast reconstruction after mastectomy

Abstract

As the demand for post-mastectomy breast reconstruction has continued to rise, options for the implantable soft-tissue replacement products which enhance the aesthetic and reconstructive outcome of these procedures has grown as well. While the most common product used in an alloplastic breast reconstruction is an acellular dermal matrix derived from human sources, many other options are currently available, each offering their own unique properties and benefits. This review presents a concise description of each of the biologic matrices currently available and discusses their use in the context of one-stage and two-stage breast reconstructions.

Keywords::

• acellular dermal matrix
• breast reconstruction
• small intestine submucosa

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in this manuscript. This includes employment, consultations, honoraria, stock ownership or options, expert testimony, grants or patients received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Alloplastic breast reconstruction utilizes tissue expanders and/or permanent implant devices to create a reconstructed breast after mastectomy.

• Alloplastic breast reconstructions are traditionally carried out in a staged fashion, with placement of a tissue expander at the initial operation, followed by filling of the expander over several outpatient visits, and completed with a second operation to remove the expander and place a permanent implant.

• More recently, with a growing trend for skin-sparing and even nipple-sparing mastectomies, single-stage alloplastic breast reconstructions have become possible, allowing for the placement of permanent implant devices at the time of the initial operation.

• Traditionally, tissue expanders and implants were placed into a total sub-pectoralis muscle pocket to maintain complete muscle coverage of the implanted device. However, more recently biologic meshes have been used as a ‘sling’ between the divided caudal edge of the pectoralis muscle and anterior chest wall to increase the volume of space that is available in this sub-pectoral pocket and to increase the control of where this pocket is positioned on the chest wall.

• Many biologic materials are available, with acellular dermal matrices being the most commonly used products in alloplastic breast reconstruction.

• While there are many advantages to using biologic materials in alloplastic breast reconstruction, recent systematic reviews of the growing body of literature indicate that they may be associated with increased rates of seroma, infection and overall reconstructive failure.

• Most of the current literature is based on retrospective cohort comparisons or descriptive reports of case series. Randomized, prospective trials are needed to better evaluate the true risks and benefits associated with biologic materials in alloplastic breast reconstruction.