title: Acellular Dermal Matrix (Permacol®) for Heterologous Immediate Breast Reconstruction after Skin-Sparing Mastectomy in Patients with Breast Cancer: A Single-Institution Experience and a Review of the Literature.
abstract: OBJECTIVE
  Skin-sparing mastectomy (SSM) with immediate heterologous reconstruction is a safe oncological option in surgical therapy of early breast cancer. Permacol®is an acellular dermal matrix (ADM) placed between the implant and the skin to improve lower pole projection and implant coverage. The aim of our study was to evaluate the outcome with a focus on patient satisfaction after 6 months and to analyze physical changes of ADM.
  
  
  METHODS
  10 patients who underwent SSM with Permacol®were analyzed retrospectively. All patients were followed using a satisfaction questionnaire and an ultrasound evaluation of the tissue thickness of the pectoralis muscle and the Permacol®.
  
  
  RESULTS
  No intraoperative complications were observed. One patient required removal of the implant for necrosis after 3 months. Half of the patients underwent secondary corrective surgery. A statistically significant thinning of the pectoralis muscle was observed, compared to the thickening of the Permacol®. A majority of the patients were satisfied with the operation, and we found a correlation between lower body mass index and patient satisfaction.
  
  
  CONCLUSIONS
  In our small case series Permacol®-assisted immediate reconstruction is shown to be an option for selected cases. Physical changes of Permacol®result in a symmetrical coverage of the implant, which may improve cosmetic outcome.
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospital of Berne, University of Berne , Berne , Switzerland.
authors.forename: Laura
authors.initials: L
authors.lastname: Knabben
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospital of Berne, University of Berne , Berne , Switzerland.
authors.forename: Gowthami
authors.initials: G
authors.lastname: Kanagalingam
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospital of Berne, University of Berne , Berne , Switzerland.
authors.forename: Sara
authors.initials: S
authors.lastname: Imboden
authors.affiliation: Department of Obstetrics and Gynaecology, Cantonal Hospital of Lucerne , Lucerne , Switzerland.
authors.forename: Andreas R
authors.initials: AR
authors.lastname: Günthert
keywords: Permacol®; acellular dermal matrices; breast cancer; heterologous immediate breast reconstruction; skin-sparing mastectomy