Options in Acellular Dermal Matrix–Device Assembly

Summary: Prepectoral prosthetic breast reconstruction has become increasingly popular during the last several years. Original shortcomings and poor outcomes in the 1970s have been overcome with the use of the bioengineered breast concept—namely, use of improved form stable breast implants, autologous fat grafting, and acellular dermal matrices (ADMs). Careful use of these reconstructive tools combined with improved mastectomy skin flaps has lead to successful early outcomes. Prepectoral breast reconstruction mitigates the animation deformities and muscle tightness previously associated with dual-plane prosthetic breast reconstruction while at the same time producing reproducible and outstanding aesthetic outcomes. The use of ADM is a critical component to performing prepectoral breast reconstruction. There are many techniques utilized to inset the ADM. Various methods of direct in vivo inset have been performed. These techniques are employed following completion of the mastectomy and are performed with both 2-stage as well as single-stage direct-to-implant reconstruction. Various ex vivo techniques have also been used for prepectoral breast reconstruction. Various prefabricated constructs of ADM and implant/tissue expander can be created on the back table while the mastectomy is in progress, which decreases operative time and improves surgical efficiency. This article will describe briefly the history of prepectoral reconstruction as well as describing the various techniques used for creating the ADM-device interphase.