Cirugía oncoplástica reconstructiva: reconstrucción prepectoral inmediata y matrices acelulares dérmicas. Revisión sistemática, indicaciones y resultados

In the last decade, we have witnessed an exponential increase in the use of acellular dermal matrices (ADMs) as a result of increased rates of immediate prepectoral breast reconstruction (IPBR) after mastectomy. We performed a systematic search on IPBR with ADMs with the aim of understanding the results obtained and identifying which subgroup of patients benefit from the use of ADMs in IPBR. We recorded the anthropometric characteristics and medical history of the patients, the therapy carried out, and the results obtained.

A total of 159 articles were identified, of which 46 were selected. These describe a reduction in the onset of global complications after IPBR with ADMs from 27.5% to 23.3%, and a reduction in the incidence of capsular contracture from 12.4% to 2.3%, as well as the disappearance of animation deformity. In this review, the following factors were found to be risk factors for morbidity and/or worse aesthetic results: adjuvant radiotherapy, smoking, larger volume mastectomy, and axillary surgery. BMI > 30, diabetes, age > 50, and prosthetic volume have not been confirmed as risk factors. Mastectomies > 1000 g have been described as protective factors. Prepectoral breast reconstruction with ADMs is a safe technique with good functional and aesthetic results. At present, it is not possible to determine which ADM provides the best results.