“A Comparative Study of Wrap-Around versus Anterior Coverage Placement of Acellular Dermal Matrix in Prepectoral Breast Reconstruction”

Background: Prepectoral direct-to-implant insertion with acellular dermal matrix (ADM) is the currently preferred surgery for breast reconstruction. There are different placements of ADM, which are largely classified as wrap-around placement or anterior coverage placement. Since there is 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 direct-to-implant breast reconstructions performed by a single surgeon between 2018 and 2020. Patients were classified depending on the ADM placement type utilized. 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 wrap-around group and 72 in the anterior coverage group. Demographics were similar between the two groups, excluding ADM usage amount (154.1 cm 2 vs. 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% vs. 5.56%, P=1.0), total drainage amount (762.1 mL vs. 805.9 mL, P=0.45) and capsular contracture (4.6% vs. 1.39%, P=0.38). The wrap-around group had a significantly longer distance change than that of the anterior coverage group in the sternal notch-to-nipple distance (4.44% vs. 2.08 %, P=0.03) and mid-clavicle-to-nipple distance (4.94% vs. 2.64%, P=0.04). Conclusion: Wrap-around and anterior coverage placement of ADM in prepectoral direct-to-implant breast reconstruction showed similar complication rates including seroma, drainage amount and capsular contracture. However, wrap-around placement can make the breast more ptotic in shape compared to anterior coverage placement.