Abstract
The technique of implant immediate breast reconstruction has been revived since the advent of acellular dermal matrices (ADM). The traditional technique involving sub-pectoral implant placement is being replaced by the re-emerging technique of muscle-sparing pre-pectoral implant placement due to the availability of ADM, which can wrapped around the implant, thereby obviating the need for any additional tissue cover. Braxon® (DECO Med s.r.l., Marcon, Italy), a novel ADM, specifically designed for breast reconstruction, is gaining popularity among surgeons in the UK and Europe. Its early outcomes seem promising; however, the literature to back its utility is still scarce. Hence, there is a need to gather and compile the existing evidence to inform the current clinical practice. A systematic review was carried out for all the original studies reporting the outcomes of pre-pectoral implant breast reconstruction with Braxon® through MEDLINE and CINAHL databases. Studies were selected and analyzed based on their level of evidence, inclusion and exclusion criteria for pre-pectoral implant breast reconstruction, and outcomes in terms of complication rates and cosmesis. Six studies (742 breast reconstructions in 600 patients) were identified for the review. All of the studies were level IV evidence case series, reporting outcomes for at least three months post-operative follow-up. All except one study mentioned patient selection criteria based on Association of Breast Surgery (ABS) and British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) guidelines. Pooled complication rates showed that total 209 (28.2%) breast reconstructions had some form of complication; major complication rate of 98 (13.2%), return to theater 90 (12.1%), implant loss 48 (6.5%), minor complications 111 (15%), seroma 74 (10%), hematoma 29 (3.9%), Red breast syndrome 38 (5.1%), infection 26 (3.5%), necrosis 26 (3.5%), and wound dehiscence 24(3.2%). The short-term pooled complication rates of pre-pectoral implant breast reconstruction with Braxon® are low and comparable with those of the sub-pectoral technique. Although preliminary data are promising; however, the long-term outcomes are yet to be analyzed in future studies.