Indications and Pitfalls of Prepectoral Breast Reconstruction with Braxon® Acellular Dermal Matrix (ADM): A preliminary plastic surgical experience

Prepectoral breast reconstruction by total implant coverage using Braxon® (Decomed SrL, Venezia, Italy) porcine Acellular Dermal Matrix (ADM) is a novel technique designed to minimize the drawbacks of subpectoral implant-breast reconstruction, notably pain and animation deformity (Figure 1).1 Although increasingly adopted by UK oncoplastic breast surgeons (Association of Breast Surgery - personal communication) the role of prepectoral breast reconstruction per se has yet to be defined especially in practices offering the full spectrum of breast reconstructions. A review of the indications and patient outcomes for Braxon® total implant coverage in a plastic surgeon's reconstructive breast surgery practice (2016-2019, minimum of 12 months follow-up) was undertaken. Our technique for Braxon® preparation and implant wrapping prior to insertion into the prepectoral pocket is illustrated in an accompanying video (Supplementary material 1). Patients were identified from the departmental prospective breast reconstruction register and data extracted from the hospital's electronic patient record system (Epic 2014, Wisconsin, USA).