Is single-stage implant-based breast reconstruction (SSBR) with an acellular matrix safe?

Nadine S. Hillberg*, Patrick I. Ferdinandus, Rieky E. G. Dikmans, Bjorn Winkens, Juliette Hommes, Rene R. W. J. van der Hulst

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background Acellular matrices (AM) might enable a direct single-stage breast reconstruction procedure resulting in an improved efficacy of the reconstruction phase for patients. Safety concerns are an important issue due to a recent study which shows that single-stage breast reconstruction with Strattice T resulted in more complications versus a two-stage reconstruction. Therefore, the goal of this study is to compare the short-and long-term complications of a single-stage breast reconstruction with the use of two types of AM (Strattice T and Meso Biomatrix (R)) versus two-stage breast reconstruction without the use of an AM. Methods Cohort study with single-stage breast reconstruction with Strattice T (n = 28) or Meso BioMatrix (R) (n = 20) or twostage breast reconstruction without an AM (n = 36) at the Maastricht Academic Hospital, the Netherlands. All complications, in particular major complications with the need for re-admission to the hospital, re-exploration, and implant explantation, were the primary outcome measures. A 1-year follow-up was achieved for all patients. Results Baseline characteristics of all 52 patients were similar between groups. There was a significantly higher complication rate in the single-stageAM groups with loss of the implant in 40.0% of the breasts from the Meso BioMatrix (R) group and in 10.7% of the Strattice T group compared to no implant loss in the control group. Conclusions This cohort study clearly suggests that the use of a single-stage breast reconstruction is not safe with the use of these AMs. Well-designed prospective studies that guarantee the safety of those matrices should be published before these AMs are used in implant-based surgery. Level of Evidence: Level III, risk /prognostic study.
Original languageEnglish
Pages (from-to)429-438
Number of pages10
JournalEuropean Journal of Plastic Surgery
Issue number4
Publication statusPublished - 1 Aug 2018


  • Acellular dermis
  • Breast implant
  • Breast reconstruction
  • Mesh matrix
  • Implant-based
  • Postoperative complications


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