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A Comparative Study of Wraparound versus Anterior Coverage Placement of Acellular Dermal Matrix in Prepectoral Breast Reconstruction

 Woo Yeon Han  ;  Seong John Han  ;  Jin Sup Eom  ;  Eun Key Kim  ;  Hyun Ho Han 
 PLASTIC AND RECONSTRUCTIVE SURGERY, Vol.152(4) : 716-724, 2023-10 
Journal Title
Issue Date
Acellular Dermis* ; Breast Implantation* / methods ; Breast Implants* ; Breast Neoplasms* / surgery ; Contracture* ; Female ; Humans ; Mammaplasty* / methods ; Nipples ; Retrospective Studies ; Seroma
Background: Prepectoral direct-to-implant insertion (DTI) with acellular dermal matrix (ADM) is the currently preferred operation for breast reconstruction. There are different placements of ADM, which are largely classified as wraparound placement or anterior coverage placement. Because there are limited data comparing these two placements, this study aimed to compare the outcomes of these two methods.

Methods: This was a retrospective study of immediate prepectoral DTI breast reconstructions performed by a single surgeon between 2018 and 2020. Patients were classified depending on the ADM placement type used. Surgical outcomes and breast shape changes using nipple position during follow-up were compared.

Results: A total of 159 patients were included in the study, with 87 in the wraparound group and 72 in the anterior coverage group. Demographics were similar between the two groups, excluding ADM amount used (154.1 cm 2 versus 137.8 cm 2 ; P = 0.01). There were no significant differences in the overall rate of complications between the two groups, including seroma (6.90% versus 5.56%; P = 1.0), total drainage amount (762.1 mL versus 805.9 mL; P = 0.45), and capsular contracture (4.6% versus 1.39%; P = 0.38). The wraparound group had a significantly longer distance change than that of the anterior coverage group in the sternal notch-to-nipple distance (4.44% versus 2.08%; P = 0.03) and midclavicle-to-nipple distance (4.94% versus 2.64%; P = 0.04).

Conclusions: Wraparound and anterior coverage placement of ADM in prepectoral DTI breast reconstruction showed similar complication rates, including seroma, drainage amount, and capsular contracture. However, wraparound placement can make the breast more ptotic in shape compared with anterior coverage placement.

Clinical question/level of evidence: Therapeutic, III.

Copyright © 2023 by the American Society of Plastic Surgeons.
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1. College of Medicine (의과대학) > Dept. of Plastic and Reconstructive Surgery (성형외과학교실) > 1. Journal Papers
Yonsei Authors
Han, Woo Yeon(한우연)
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