Porcine-derived acellular dermal matrix in primary augmentation mammoplasty to minimize implant-related complications and achieve an internal mastopexy: a case series

Acellular dermal matrix in breast augmentation surgery: A systematic review

Background

The use of acellular dermal matrix (ADM) in breast reconstruction was described for the first time in 2000s. Recently, ADMs have been used not only in reconstructive surgery but also in cosmetic breast surgery for both primary and revision indications. Therefore, the matrices represent an important support to recent surgical techniques for breast augmentation in treatment or prevention of complications. Conversely, ADMs can affect operative times, costs, and additional complications related to their placement. A review of the literature was carried out to evaluate the efficacy, safety, and indication for the use of these matrices in cosmetic breast surgery.

Methods

A literature review was conducted including manuscripts published up to April 2023 on breast augmentation using ADM. PubMed and MEDLINE were the databases used for research. The keywords used were "Breast augmentation" and "Acellular Dermal Matrix." Non-English language articles have been excluded.

Results

The initial search for "breast augmentation" yielded 7900 results, which were further reviewed for "Acellular Dermal Matrices" in breast augmentation, selecting 74 articles. Following further screening, 12 articles were included in the review. A total of 787 patients were treated with breast augmentation and ADM placement. The main indication was capsular contracture (60%).

Conclusions

The current evidence from the published scientific literature, albeit limited, suggests the indication for the use of ADM in revision surgery, to support the prosthetic pocket, to minimize the risk of capsular contracture and its recurrence.

The use of eponyms in medical case reports: etymological, quantitative, and structural analysis

BACKGROUND

The present paper focuses on eponyms, that is, terms with proper names, in particular, derived from world mythologies, the Bible, and modern literature. The study highlights the significance of this terminological phenomenon in the English sublanguage of medicine and discusses its role in the process of writing medical case reports. The objectives of the research are to study the prevalence of eponyms in the English language in medical case reports and to analyze the etymology of the revealed terms. The deeper purpose of our study is to demonstrate that eponymic terms in general, and mythological and literary eponyms, in particular, are present in doctors' spoken and written discourse far more extensively than might seem at first glance. By drawing attention to this terminological phenomenon, we will provide relevant guidelines, which will ensure the correct use of eponyms by medical professionals who will deal with the genre of medical case reports.

METHODS

We studied the prevalence of these terms in the issues of Journal of Medical Case Reports (2008-2022) and classified them according to their etymological origin and frequency of use. The selected medical case reports were considered using the methods of quantitative examination, and structural, etymological, and contextual analyses.

RESULTS

We detected the major tendencies in using mythological and literary eponyms in medical case reports. We found a total of 81 mythological and literary eponyms, represented by 3995 cases of use in Journal of Medical Case Reports issues, and traced the etymology of their onomastic components. Hence, we delineated the five most prevalent sources of these terminological units: Greek mythology, Roman mythology, other world mythologies, the Bible, and fiction. The research revealed that modern medical case reports largely rely primarily on Greek mythology (65 eponyms, 3633 results), which is due to a rich informational and metaphorical arsenal of these ancient corpora of human knowledge. The group of eponyms rooted in Roman mythology ranks second, and these terms are much less prevalent in modern medical case reports (6 eponyms, 113 results). Four eponyms (88 results) represent other world mythologies (Germanic and Egyptian). Two terms with onomastic components come from the Bible (15 results), and four eponyms stem from modern literature (146 results). We also detected several widespread mistakes in the spelling of some mythological and literary eponyms. It is our opinion that the awareness of an eponym's etymology can effectively prevent and minimize the appearance of such errors in medical case reports.

CONCLUSIONS

The adequate use of mythological and literary eponyms in medical case reports is an effective way to share one's clinical findings with colleagues from all over the world, because these eponyms are internationally widespread and understood. Correct use of eponyms promotes the continuity of medical knowledge and ensures conciseness and brevity, which are indispensable features of medical case reports as a genre. Therefore, it is highly important to draw students' attention to the most prevalent mythological and literary eponyms, used in contemporary medical case reports, so they could use them appropriately, as well as with due awareness of the origin of these terms. The study also demonstrated that medicine and humanities are closely related and inherently interconnected areas. We believe that the study of this group of eponyms should be an integral component of doctors' training and continuing professional education. This will ensure the interdisciplinary and synergic approach in modern medical education, which in turn will promote the all-round development of future healthcare specialists, endowed not only with professional expertise, but also with extensive background knowledge.

Braxon®-assisted prepectoral breast reconstruction: A decade later

We are sitting on the cusp of the bioengineered breast era, in which implant-based breast reconstruction is seeing a growing trend and biotechnology research progressively empowers clinical practice. As never before, the choice of biomaterials has acquired great importance for achieving reconstructive outcomes, and the increase in the use of acellular dermal matrices (ADMs) in the field of senology tells us a story of profound upheaval and progress. With the advent of prepectoral breast reconstruction (PPBR), plenty of devices have been proposed to wrap the silicone prosthesis, either completely or partially. However, this has caused a great deal of confusion and dissent with regard to the adoption of feasible reconstructive strategies as well as the original scientific rationale underlying the prepectoral approach. Braxon^® is the very first device that made prepectoral implant positioning possible, wrapping around the prosthesis and exerting the proven ADM regenerative potential at the implant–tissue interface, taking advantage of the body's physiological healing mechanisms. To date, the Braxon^® method is among the most studied and practiced worldwide, and more than 50 publications confirm the superior performance of the device in the most varied clinical scenarios. However, a comprehensive record of the working of this pioneering device is still missing. Therefore, our aim with this review is to lay a structured knowledge of surgery with BRAXON^® and to provide a decision-making tool in the field of PPBR through a complete understanding on the very first device for prepectoral, one decade after its introduction.

Mastopexy: with or without Acellular Dermal Matrix?

In the years after unilateral breast reconstruction, the reconstructed breast resists ptosis more than natural breast tissue in the native contralateral breast. As acellular dermal matrix (ADM) becomes fully incorporated into the recipient's anatomy, thus reinforcing the inferior pole of the uplifted breast, we combined our mastopexy cases with ADM in an attempt to reduce the rate of recurrent ptosis.

Method

This was a prospective randomized analysis of a cohort of 24 patients, divided into two groups (A and B); all underwent primary unilateral mastopexy to correct grade III breast ptosis. Our patients had previously undergone contralateral skin sparing mastectomy with immediate breast reconstruction, for invasive breast cancer or ductal carcinoma in situ that originally was symmetrical to their native breast. The symmetrization mastopexy in half of our patients was carried out with the addition of an ADM sling to the inferior pole of the breast, to act as an internal, subcutaneous supportive "bra" (A). The other half of patients received a standard symmetrization mastopexy, without the addition of an ADM support (B). Patients were followed up for 36 months.

Results

The difference between control arm and study groups revealed a statistical difference (P < 0.05), when comparing the follow-up period. From the sixth postoperative month onward, the measurements for group A revealed a statistically significant difference (P < 0.05) when compared with group B.

Conclusion

The additional ADM sling acts as an added layer of support, thus delaying reoccurrence of ptosis following mastopexy.

Augmentation Mastopexy with a Dermal Encapsulated Round or Anatomic Autoprosthesis

INTRODUCTION

Several factors, such as aging, pregnancy, and weight loss, reduce the elasticity of the breast tissue, and ptosis occurs. Due to aging and gravity, it is not possible to completely prevent breast ptosis. The goal is to delay the recurrence of ptosis as much as possible.

PATIENTS AND METHODS

This study included 20 female patients aged 25-55 years. The patients who underwent surgery had different levels of ptosis. Although the patients wanted their breasts to be lifted and an increase in projection, they did not want implants to be used. For this reason, autologous flaps were prepared from the patients, and these flaps were called autoprosthesis flaps. The flap donor area (FA) boundaries consisted of the inframammary fold at the bottom, the medial and lateral pillar legs at the two sides and the lower margin of the areola at the top. The skin on the FA was de-epithelialized. A hand dermatome was used to ensure that the extracted skin was not too thick because the rest of the dermal skin would form the cover of the planned autoprosthesis flap. Before surgery, the autoprosthesis flap baseline width, projection, and shape (round or anatomic) were planned for each patient. The autoprosthesis flap was prepared as a central pedicle, and the dermal layer, which was 1 cm wider than the flap, was then attached over the autoprosthesis flap to the pectoral muscle fascia with at least 10 sutures in the recipient area. For a round autoprosthesis flap, the flap base diameter was 10-12 cm on average, whereas for an anatomic autoprosthesis flap, the width of the flap was 10-12 cm and the height was 12-14 cm. Autoprosthesis flap projections varied from 4 to 6 cm.

RESULTS

Because of the autoprosthesis flap, breast projection was more prominent, even in the lying position. All the patients were very satisfied with their size, shape, projection, and natural appearance. In particular, the image in the lying position was very similar to a mastopexy performed with an actual breast implant; thus, sagging was not observed.

CONCLUSION

In augmentation mastopexy patients who do not want implants, upper pole filling and adequate breast projection can be easily achieved with this method. The potential risks of capsule formation, implant rejection, and implant rupture were not observed with this technique.

LEVEL OF EVIDENCE V

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 .

Capsular Contracture after Breast Augmentation: An Update for Clinical Practice

Capsular contracture is the most common complication following implant based breast surgery and is one of the most common reasons for reoperation. Therefore, it is important to try and understand why this happens, and what can be done to reduce its incidence. A literature search using the MEDLINE database was conducted including search terms 'capsular contracture breast augmentation', 'capsular contracture pathogenesis', 'capsular contracture incidence', and 'capsular contracture management', which yielded 82 results which met inclusion criteria. Capsular contracture is caused by an excessive fibrotic reaction to a foreign body (the implant) and has an overall incidence of 10.6%. Risk factors that were identified included the use of smooth (vs. textured) implants, a subglandular (vs. submuscular) placement, use of a silicone (vs. saline) filled implant and previous radiotherapy to the breast. The standard management of capsular contracture is surgical via a capsulectomy or capsulotomy. Medical treatment using the off-label leukotriene receptor antagonist Zafirlukast has been reported to reduce severity and help prevent capsular contracture from forming, as has the use of acellular dermal matrices, botox and neopocket formation. However, nearly all therapeutic approaches are associated with a significant rate of recurrence. Capsular contracture is a multifactorial fibrotic process the precise cause of which is still unknown. The incidence of contracture developing is lower with the use of textured implants, submuscular placement and the use of polyurethane coated implants. Symptomatic capsular contracture is usually managed surgically, however recent research has focussed on preventing capsular contracture from occurring, or treating it with autologous fat transfer.