The comparison outcome of implant-based breast reconstruction with acellular dermal matrix, non-acellular dermal matrix and TiLOOP® reconstruction in breast cancer patients.

BACKGROUND: Implant-based breast reconstruction after mastectomy in breast cancer patients has been increasingly performed over the past decade, improving cosmetic outcomes. The use of supportive matrices has increased in recent years. This study aimed to compare the outcomes of implant-based breast reconstruction between acellular dermal matrix (ADM), non-ADM, and TiLOOP® bra mesh in breast cancer patients. METHODS: A retrospective descriptive study, a case series from consecutive patients with breast cancer who underwent mastectomy with implant-based breast reconstruction using ADM, non-ADM, or TiLOOP® by one senior surgeon (V.L., M.D.) at a single center at Siriraj Hospital between 2018 and 2022. Fisher's exact test was used for the analysis. Demographic data and the history of radiotherapy in each patient were collected. The primary outcomes focus on the significant complications of explantation, implant loss, capsular contracture, skin necrosis, and infection. The secondary outcomes focus on the local recurrence rate and metastasis. Additional surgical interventions to correct the complications were reported. RESULTS: A total of 36 breast cancer patients (ages between 22 and 64 years old) who underwent unilateral or bilateral mastectomy with implant-based breast reconstruction were organized into three categories of ADM, non-ADM, and TiLOOP®. The mean follow-up was 2 years and 3 months, with a range of 1 year and 2 months to 4 years. There were 10 patients in the ADM group, 19 in the non-ADM group, and 7 in the TiLOOP® group. In the ADM group, there were 2 infections (20.0%), 1 necrosis (10.0%), and 2 capsular contractures (20.0%). In the non-ADM group, there were 2 explantations (10.5%), 2 capsular contractures (10.5%), 2 local recurrences (10.5%), and 1 metastasis (5.3%). In the TiLOOP® group, there were 2 capsular contractures (28.6%). In the TiLOOP® group, two patients who received adjuvant radiotherapy developed capsular contracture: one developed grade III and the other developed grade IV. There was 1 patient in the non-ADM group who had previous chest wall radiation before reconstruction and developed capsular contracture grade IV without postoperative radiotherapy. All capsular contracture grade III or IV cases required additional revision breast surgery. CONCLUSIONS: No significant difference in complication between ADM, non-ADM and TiLOOP® implant-based breast reconstruction (P>0.05). The limitations of this study were a low number of cases and short-term follow-up.