“Prepectoral tissue expanders without mesh as a bridge to delayed autologous breast reconstruction: Experience at a single academic center”

Acellular dermal matrix (ADM) is a useful adjunct in implant-based breast reconstruction. The benefits of using ADM with an expander as a temporary bridge to delayed autologous reconstruction are unknown. Placing prepectoral tissue expanders, without ADM, as a bridge to delayed autologous reconstruction could yield cost savings, shorten operating time and decrease complications. This investigation seeks to demonstrate the safety of placing prepectoral tissue expanders without ADM at the time of mastectomy as the first stage of autologous breast reconstruction. A retrospective, chart review was performed at our major academic institution between 2015 and 2020. Included were female patients, 18 years or older at the time of reconstruction, who underwent mastectomy with prepectoral tissue expander placement followed by autologous breast reconstruction at a delayed second stage. Excluded were patients of male gender, younger than 18, patients with lumpectomy only, subpectoral reconstruction, or immediate autologous reconstruction. Data on ADM, patient demographics, comorbidities, and cancer treatment were collected. There were 189 reconstructed breasts of which 56 (29.6 %) used ADM, 131 (69.3 %) did not use ADM, and 2 patients (1.1 %) of unknown ADM use. Expanders were in place for a mean time of 8.9±6.2 months. There was no statistically significant difference in complication rates between the ADM and no-ADM groups. Therefore, not wrapping prepectoral tissue expanders in ADM, at the time of mastectomy, has an equivalent rate of complications compared to ADM wrapping among patients who go on to have second stage autologous breast reconstruction.