Anterior tenting vs. whole wrapping technique for acellular dermal matrix in breast reconstruction under post-mastectomy radiotherapy in rats

In this experimental study, we compared the outcomes between anterior-tenting and wrapping techniques in prepectoral breast reconstruction using an acellular dermal matrix (ADM). Fifteen rats were divided into control, anterior-tenting, and whole-wrapping groups, each receiving two silicone implants. In the control group, only silicone implants were placed, whereas in the anterior-tenting and whole-wrapping groups, the anterior surface of the implants and the entire implants were covered with ADM, respectively. The Animals were irradiated on one side of the back 3 weeks postoperatively and sacrificed 3 months postoperatively. The range of change in tonometry values with or without irradiation in the whole-wrapping group tended to be larger than that in the anterior-tenting group (p < 0.05). The cellular capsule was significantly thinner on the side covered by ADM (p < 0.05). There were no significant differences in other microscopic features of the cellular capsule. Microscopic analysis of the ADM revealed significant increases in thickness and collagen density with radiation exposure, whereas a significant decrease was observed in the α-smooth muscle actin-positive area, CD3-positive cell counts, and F4/80 positive area (p < 0.05). In our rat model, the whole wrapping technique led to a greater increase in intraprosthetic pressure due to radiation-related structural changes in ADM, compared to the anterior-tenting technique.