Clinical efficacy and safety of acellular dermal matrix as a method of volume replacement after breast-conserving surgery

Clinical efficacy and safety of acellular dermal matrix as a method of volume replacement after breast-conserving surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical efficacy and safety of acellular dermal matrix as a method of volume replacement after breast-conserving surgery JinAh Kwon, Jung Hee Byon, Byung Kyun Ko, Jin Sung Kim, Minseo Bang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3277351/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The cosmetic outcome of breast conserving surgery (BCS) has recently gained attention, and surgeons are exploring the use of the acellular dermal matrix (ADM), a safe and effective method of breast reconstruction. This study evaluated the safety and effectiveness of the sheet-type ADM for reconstruction after BCS. Method The study included 137 patients who underwent BCS using ADM in a single center between October 2019 and October 2021. During surgery, a sheet-type ADM was folded and inserted according to the size and shape of the excised defect. Complications and cancer recurrence were evaluated during surveillance follow-up, and maintenance of the inserted ADM was evaluated quantitatively using volume analysis on CT scan. Results Of the 137 patients, 16 had minor complications and 17 underwent biopsy during the surveillance period. One patient was diagnosed with recurrence. The volume of the ADM was measured in 67 patients, and the mean volume difference between the first and last CT scans was 2.65 ± 2.20 cm 3 (p = 0.000). Conclusion Insertion of ADM is an effective and safe method to fill the volume defect after BCS despite the slight volume change, and it does not interfere with postoperative surveillance. Acellular dermal matrix Breast conserving surgery Breast cancer Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Breast conserving surgery (BCS) is the one of the most common surgical procedures in South Korea. BCS is an oncologically safe method that aims to preserve the breast [ 1 ]. During BCS, in addition to removing the tumor with adequate margins, many surgeons are concerned with the cosmetic aspect, namely, maintaining the shape of the breast [ 2 ]. Oncoplastic surgery is a new approach that addresses these two issues. Volume displacement is a type of oncoplastic surgery in which the defect is filled using the surrounding breast tissue. However, because Korean women have relatively small breasts, achieving satisfactory cosmetic results using the volume displacement method is difficult [ 3 , 4 ]. In addition, this method is associated with long scars and a long recovery period [ 5 ]. Another oncoplastic surgery method to fill the defect after BCS is volume replacement, which can be performed using an acellular dermal matrix (ADM) to replace the volume. ADM is derived from human skin tissue that has undergone decellularization[ 6 ]. This process removes cells and immunogenic substances to prevent immune rejection and inflammation after transplantation, and the remaining scaffold of connective tissue serves as a matrix for re-epithelialization, neovascularization, and fibroblast infiltration[ 6 ]. ADMs are widely used for implant-based breast reconstruction to supplement cosmesis, and their safety and effectiveness have been demonstrated[ 7 – 9 ]. The use of the ADM as a volume filler in BCS is currently being explored, and there are few reports on the effectiveness of this method for BCS[ 10 , 11 ]. Paik et al. and Gwak et al. used ADMs in breast cancer patients undergoing BCS and showed that this method is easy and safe with satisfactory cosmetic outcomes[ 10 , 11 ]. However, to the best of our knowledge, the safety and efficacy of breast volume maintenance have not been evaluated quantitatively during surveillance follow-up. In this study, the outcomes of the inserted ADM were evaluated quantitatively using computed tomography (CT) scan volume analysis, and the complications and recurrence of cancer were evaluated during surveillance follow-up. Materials and Methods The study protocol was approved by the Institutional Review Board of Ulsan University Hospital (IRB number: 2023-01-003-001). Patients A total of 137 patients who underwent BCS in a single institution between October 2019 and October 2021 were retrospectively enrolled. Patients who were likely to develop a deformity of the breast contour after BCS were included. All patients provided consent regarding the insertion of an ADM. Regardless of tumor size and location, patients who underwent insertion of a 5 × 7 cm sheet-type ADM were inserted. Demographic data, histologic type, tumor stage, tumor location, and adjuvant radiotherapy were recorded. During the surveillance follow-up period until December 2022, complications associated with the operation were recorded. Lesions assessed as Breast Imaging Reporting and Data System (BI-RADS) Category 4A[ 12 ] or higher that were detected on surveillance imaging follow-up studies, and the results of pathological analysis of these lesions, were reported. Surgical technique A 5 × 7 cm sheet-type ADM (CGderm®, CGBIO Inc., Seongnam, Korea) was used. One sheet was used per patient. Patients received intravenous cephalosporin as preoperative and postoperative antibiotics, which is the protocol used for all patients undergoing breast cancer surgery. Before surgery, the ADM was immersed in sterile normal saline. The size of the incision was determined according to the location and size of the tumor, and the mass was excised to achieve negative margins. In the excision cavity, the breast tissue was resected for frozen biopsy. After confirming negative results of the frozen biopsy, the fibroglandular tissue was undermined from the skin to reposition the breast tissue. First, tissue reapproximation was used to close the glandular defect left after tumor excision. Then, the ADM was inserted into the area of the defect cavity that could not be closed; if necessary, it was folded once to fit the size of the defect. The ADM was fixed to the surrounding tissue using Vicryl 2 − 0, and the area was examined to ensure that there was no dimpling or convex rise of the skin. To protect the ADM, the subcutaneous fat overlying the ADM was approximated and the skin was closed. A Jackson-Pratt (JP) drain was inserted for seroma drainage, if necessary, as determined by the surgeon. The JP drain was removed after 2–3 days when the drain volume was < 30 cc. ADM volume analysis Volumetric analyses were performed in patients who underwent CT scans of the chest region at 1 and 12 months after the operation. Patients with the following complications were excluded from the study: infection, postoperative fluid collection, and air collection. Volumetric analyses were performed using Siemens syngo.via VB 30B software (Siemens Healthcare, Erlangen, Germany). Image analysis was performed by a breast radiologist with 10 years of experience and a breast surgeon with 5 years of experience. ADM pockets were identified and delineated every 3–4 image slices on trans-axial pre-contrast CT scanning images. The software calculates the volume semiautomatically following the line defined by the radiologist. This analysis was performed using CT images obtained at 1 month and at the last CT scan after surgery (Fig. 1). Statistical analysis Statistical analysis was performed using SPSS software (version 21.0; IBM Corp, Armonk, NY, USA). A P-value < 0.05 was considered statistically significant. The ADM volume was compared between the first and last CT scans using the paired t-test, and the association between ADM volume changes and postoperative elapsed time was assessed using Pearson’s correlation analysis. Results The characteristics of the 137 patients included in the study are shown in Table 1 . The mean age was 51.4 years, weight was 59.0 kg, and BMI was 23.3 kg/m 2 . Tumor location was the upper outer quadrant in 56 patients, upper inner quadrant in 35 patients, lower outer quadrant in 30 patients, lower inner quadrant in eight patients, and central location in nine patients. Of 137 patients, 132 patients underwent adjuvant radiation therapy. Table 1 Characteristics of included patients Characteristics Age (years) 51.4 ± 7.6 (27–69) Height (cm) 159 ± 4.97 (147–169) Weight (Kg) 59.0 ± 8.37 (35.0-84.8) BMI (kg/m 2 ) 23.3 ± 3.11 (15.3–31.6) T stage ypT0 pTis/ypTis pT1/ypT1 pT2/ypT2 4 30(29/1) 72(71/1) 31(29/2) Pathology DCIS IDC ILC Others 29 99 4 5 Location Upper outer quadrant (UO) Upper inner quadrant (UI) Lower outer quadrant (LO) Lower inner quadrant (LI) Central* 56 35 30 8 8 Adjuvant radiotherapy Yes No 132 5 Mean ± SD (Range) pT = pathologic T staging; ypT = pathologic T staging following neoadjuvant chemotherapy; DCIS = ductal carcinoma in situ; IDC = invasive ductal carcinoma; ILC = invasive lobular carcinoma. * Central was defined as cancer within 1 cm of nipple or subareolar lesion The complications of the use of ADM included seroma, which was the most common complication, in ten patients, hematoma in five patients, and redness in one patient at the first outpatient clinic visit. There were no major complications requiring reoperation, and none of the patient required removal of the ADM. Seventeen patients underwent biopsy because a Category 4A lesion was detected in the ipsilateral breast during the surveillance follow-up (Table 2 ). In these patients, most of the biopsy results were benign, and one patient was diagnosed with a recurrence. This patient refused adjuvant radiotherapy and chemotherapy after the first surgery and relapsed after 6 months. Suspicious findings on mammography and ultrasonography were noted, and a more definite lesion was observed on breast magnetic resonance imaging (MRI) (Fig. 2). No interval cancer was detected during the surveillance follow-up period. Table 2 Biopsy on subsequent follow up examination Imaging modality Patient number Pathology Mammography Ultrasonography Magnetic resonance imaging Computed tomography 1 Fat necrosis No Yes Yes No 2 Fibrocystic change No Yes No No 3 Fibrocystic change No Yes Yes No 4 Stromal fibrosis No Yes No No 5 Fat necrosis No Yes Yes No 6 Stromal fibrosis No Yes No No 7 Fibrocystic change No Yes No No 8 Fibrocystic change No Yes No No 9 Interlobular fibrosis No Yes No No 10 Interlobular fibrosis No Yes No No 11 Interlobular fibrosis No Yes Yes No 12 Fibrocystic change No Yes No No 13 Fibroadenoma No Yes No No 14 Stromal fibrosis No Yes Yes No 15 Fibrocystic change No Yes No No 16 Invasive ductal carcinoma Yes Yes Yes Yes 17 Stromal fibrosis No Yes No No Yes: The suspected lesion is visible in imaging modality. No: The suspected lesion is not visible in imaging modality. A total of 67 patients were included in the volume analysis (Fig. 1e). The mean follow-up interval between CT scans was 574 days (range, 336–1081 days). The average ADM volume was 12.80 ± 2.48 cm 3 (6.5–17.92) at the first CT scan and 10.15 ± 2.95 cm 3 (3.22–16.34) at the last CT scan. The mean ADM volume difference between the first and last CT scans was 2.65 ± 2.20 cm 3 and the difference was statistically significant (p = 0.000). The percentage difference between the first and last CT scans was 21.01 ± 17.31%. There was a significant correlation between differences in volume and the number of days between the first and last CT scans (r = 0.418, p = 0.000) (Fig. 3 ). Discussion The present study quantitatively analyzed changes in ADM volume to determine the effectiveness of the inserted ADM after BCS. The volume decreased by a mean 2.67 cm 3 during a mean follow-up period of 574 days and continued to decrease over time. The reason for this decrease has been explained in several studies. Qing-Qing Qiu et al.[ 13 ] reported that E-beam irradiation sterilization cuts the collagen matrix of the ADM. Other studies also report that the gamma and E-beam irradiation used for sterilization accelerate the rate of collagen fiber degradation and fragmentation in the ADM[ 14 , 15 ]. The increased rate of degradation and fragmentation compromises the tensile strength of the ADM[ 14 , 15 ]. Since most patients who have undergone BCS surgery undergo radiation therapy, it is accepted that some shrinkage of the ADM will occur. Although a decrease in ADM volume was observed, the decrease was only about 2–3 cm 3 , which is small and unlikely to have a significant effect on the volume of the breast. In addition, breast volume is reduced in patients who received radiation therapy after conventional BCS. Cho et al. and Chung et al. reported a 17.6% decrease in the volume of the lumpectomy cavity, and a 5% decrease in the tumor bed, in patients who received radiation therapy[ 16 , 17 ]. Considering the decrease in breast volume after radiation therapy, it is unlikely that a decrease in the volume of the ADM would lead to a significant effect on cosmesis. However, since we observed a decrease in the volume of the ADM over time, future evaluation should extend over a longer period. The use of ADMs is associated with potential complications. In this study, 16 patients had minor complications, most of which were seroma (as reported in other studies[ 18 , 19 ]). The incidence of seroma in patients undergoing conventional BCS is 9–11%[ 20 , 21 ], indicating that the use of an ADM in this study was not associated with an increased risk of complications. One patient had a suspected infection, which improved after 3 days of oral antibiotics. None of the patients required removal of the ADM. Consistent with previous studies, the present results indicate that this is a safe method. During postoperative surveillance using breast ultrasonography (US), visibility may be limited by the fibrogenetic action induced by the ADM[ 11 , 22 – 24 ]. The inserted ADMs appear as well circumscribed masses with a density similar to that of fibroglandular tissue on mammography, and iso- or hypoechoic on US; therefore, ADMs may make detecting cancer recurrence more difficult[ 6 , 11 , 14 , 23 ]. The patients included in this study were examined by breast MRI and breast US according to the follow-up protocol of our hospital. The surveillance examination detected a Category 4a lesion in the ipsilateral breast in 17 patients, and one patient was diagnosed with a recurrence. During the follow-up period, there was no interval cancer in the included patients. An et al. reported that breast MRI is more effective than mammography or US for the detection of ipsilateral local tumor recurrence in patients who undergo BCS with ADMs despite the postoperative changes caused by ADMs[ 25 , 26 ]. This study had several limitations. First, it was a retrospective, single-center study. Second, all patients included in this study were not applied, and only 67 of the patients included in this study underwent volume analysis. Third, subjective aesthetic or visual satisfaction was not evaluated because there are no validated tools and no consensus on how the evaluation should be performed. In conclusion, insertion of ADM after BCS is an effective and safe method to fill the volume defect, despite the slight change in volume of ADM. In addition, the ADM does not interfere with postoperative surveillance. Declarations Ethical Approval The study protocol was approved by the Institutional Review Board of Ulsan University Hospital (IRB number: 2023-01-003-001). Competing interests Not applicable Authors' contributions Bang, Kwon and Kim designed the study, wrote the manuscript, and collected the corresponding datasets. Kwon, Ko and Byon drew the figures as well as tables. Bang and Kim supervised the whole project and edited the manuscript. All authors read and approved the final manuscript. Funding Not applicable Availability of data and materials Data cannot be shared openly but are available on request from authors. References Kang SY, Lee SB, Kim YS, Kim Z, Kim HY, Kim HJ, et al. Breast cancer statistics in Korea, 2018. J Breast Cancer. 2021;24:123–37. Masetti R, Pirulli PG, Magno S, Franceschini G, Chiesa F, Antinori A. Oncoplastic techniques in the conservative surgical treatment of breast cancer. Breast Cancer. 2000;7:276–80. Kim SY, Ph D. Comparison of wound closure using ADM with primary wound closure after BCS in breast cancer patients. 2022;10:12–7. Yang JD, Lee JW, Kim WW, Jung JH, Park HY. Oncoplastic surgical techniques for personalized breast conserving surgery in breast cancer patient with small to moderate sized breast. J Breast Cancer. 2011;14:253–61. Clough KB, Kaufman GJ, Nos C, Buccimazza I, Sarfati IM. Improving breast cancer surgery: A classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol. 2010;17:1375–91. Lee JH, Kim HG, Lee WJ. Characterization and tissue incorporation of cross-linked human acellular dermal matrix. Biomaterials [Internet]. 2015;44:195–205. Available from: http://dx.doi.org/10.1016/j.biomaterials.2014.12.004 Sorkin M, Qi J, Kim HM, Hamill JB, Kozlow JH, Pusic AL, et al. Acellular Dermal Matrix in Immediate Expander/Implant Breast Reconstruction: A Multicenter Assessment of Risks and Benefits. Plast Reconstr Surg. 2017;140:1091–100. Hallberg H, Rafnsdottir S, Selvaggi G, Strandell A, Samuelsson O, Stadig I, et al. Benefits and risks with acellular dermal matrix (ADM) and mesh support in immediate breast reconstruction: a systematic review and meta-analysis. J Plast Surg Hand Surg [Internet]. 2018;52:130–47. Available from: https://doi.org/10.1080/2000656X.2017.1419141 Cabalag MS, Rostek M, Miller GS, Chae MP, Quinn T, Rozen WM, et al. Alloplastic adjuncts in breast reconstruction. Gland Surg. 2016;5:158–73. An J, Kwon H, Lim W, Moon BI, Paik NS. The comparison of breast reconstruction using two types of acellular dermal matrix after breast-conserving surgery. J Clin Med. 2021;10. Gwak H, Jeon YW, Lim ST, Park SY, Suh YJ. Volume replacement with diced acellular dermal matrix in oncoplastic breast-conserving surgery: A prospective single-center experience. World J Surg Oncol. 2020;18:1–7. Acr. 2013 ACR BI-RADS Atlas: Breast Imaging Reporting and Data System. Pomerleau J, Connor J. Terminal Sterilization of Biological Tissue Matrix Using Supercritical CO 2 Qing-Qing. Nilsen TJ, Dasgupta A, Huang YC, Wilson H, Chnari E. Do Processing Methods Make a Difference in Acellular Dermal Matrix Properties? Aesthet Surg J. 2016;36:S7–22. Lewandowska H, Eljaszewicz A, Poplawska I, Tynecka M, Walewska A, Grubczak K, et al. Optimization of novel human acellular dermal dressing sterilization for routine use in clinical practice. Int J Mol Sci. 2021;22. Cho H, Kim C. Volumetric changes in the lumpectomy cavity during whole breast irradiation after breast conserving surgery. Radiat Oncol J. 2011;29:277. Chung MJ, Suh YJ, Lee HC, Kang DG, Kim EJ, Kim SH, et al. Tumor bed volumetric changes during breast irradiation for the patients with breast cancer. Radiat Oncol J. 2013;31:228–33. Kim H Il, Kim BS, Kim YS, Yi HS, Park JH, Choi JH, et al. Review of 107 Oncoplastic Surgeries Using an Acellular Dermal Matrix with the Round Block Technique. J Clin Med. 2022;11. Israeli Ben-Noon H, Farber N, Weissman O, Tessone A, Stavrou D, Shabtai M, et al. The effect of acellular dermal matrix on drain secretions after immediate prosthetic breast reconstruction. J Plast Surg Hand Surg. 2013;47:308–12. Gonzalez EA, Saltzstein EC, Riedner CS, Nelson BK. Seroma formation following breast cancer surgery. Breast Journal. 2003;9:385–8. Mohamedahmed AYY, Zaman S, Zafar S, Laroiya I, Iqbal J, Tan MLH, et al. Comparison of surgical and oncological outcomes between oncoplastic breast-conserving surgery versus conventional breast-conserving surgery for treatment of breast cancer: A systematic review and meta-analysis of 31 studies. Surg Oncol. Elsevier Ltd; 2022. Lee J, Yang JD, Lee JW, Li J, Jung JH, Kim WW, et al. Acellular dermal matrix combined with oxidized regenerated cellulose for partial breast reconstruction: Two case reports. Medicine. 2020;99:e21217. Franceschini G. Internal surgical use of biodegradable carbohydrate polymers. Warning for a conscious and proper use of oxidized regenerated cellulose. Carbohydr Polym. Elsevier Ltd; 2019. p. 213–6. Franceschini G, Visconti G, Sanchez AM, Di Leone A, Salgarello M, Masetti R. Oxidized regenerated cellulose in breast surgery: Experimental model. Journal of Surgical Research. 2015;198:237–44. Kim MY, Suh YJ, An YY. Imaging surveillance for the detection of ipsilateral local tumor recurrence in patients who underwent oncoplastic breast-conserving surgery with acellular dermal matrix: abbreviated MRI versus conventional mammography and ultrasonography. World J Surg Oncol [Internet]. 2021;19:1–10. Available from: https://doi.org/10.1186/s12957-021-02403-2 Lee HS, Kim KS. Follow-Up after Volume Replacement Using Acellular Dermal Matrix in Oncoplastic Breast-Conserving Surgery. Clinical Ultrasound. 2022;7:54–7. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3277351","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":230321323,"identity":"00208d52-bc59-4ab4-87f6-54dc36a85c43","order_by":0,"name":"JinAh Kwon","email":"","orcid":"","institution":"Ulsan University Hospital, Ulsan University College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"JinAh","middleName":"","lastName":"Kwon","suffix":""},{"id":230321324,"identity":"523596e9-0fb5-4b4a-943e-0fe1f308ada7","order_by":1,"name":"Jung Hee Byon","email":"","orcid":"","institution":"Ulsan University Hospital, Ulsan University College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jung","middleName":"Hee","lastName":"Byon","suffix":""},{"id":230321325,"identity":"b8c10332-1102-42d0-80b6-ea80bd54c375","order_by":2,"name":"Byung Kyun Ko","email":"","orcid":"","institution":"Ulsan University Hospital, Ulsan University College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Byung","middleName":"Kyun","lastName":"Ko","suffix":""},{"id":230321326,"identity":"cfee9845-2fe7-46f3-bcc6-311c34d69c07","order_by":3,"name":"Jin Sung Kim","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIiWNgGAWjYFCCBDDJY3+8gYEZyJAB8RgbCGk5wMAgx3DmAFgLD9FajBluJBCphb89O/Hxx7a6xMaZb8ykCxgO88i3nz3AOHMPbi0SZ95uNjjYdjixWTrHTHoGUIvBmbwExg3P8FhzI3ebxMG2A4ltIC08IC0MOQaMDw7g1iF/I3f7j4NAh/VInoFoke9/g1+LAdAWhoNtzMYSEjwQLQw3gLZswKPFEOgXiTPnDssZ8KQVW/MYpPMY3HhjcHAGHi1yx3M3fqgoq+MxYD+88TZPhbWcfH+O4cMePFrQ3QmhiNcwCkbBKBgFowArAADvglP9ogPokQAAAABJRU5ErkJggg==","orcid":"","institution":"Ulsan University Hospital, Ulsan University College of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Jin","middleName":"Sung","lastName":"Kim","suffix":""},{"id":230321327,"identity":"a8d8b85b-5933-4251-9750-567116fc428e","order_by":4,"name":"Minseo Bang","email":"","orcid":"","institution":"Ulsan University Hospital, Ulsan University College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Minseo","middleName":"","lastName":"Bang","suffix":""}],"badges":[],"createdAt":"2023-08-19 08:59:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3277351/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3277351/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":42669525,"identity":"a37f7321-1ea2-46f9-a629-aaa5e2ff478e","added_by":"auto","created_at":"2023-09-05 22:51:13","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":223281,"visible":true,"origin":"","legend":"\u003cp\u003eApplication of the volume analysis tool\u003c/p\u003e\n\u003cp\u003eA. The reader manually draws a line every 3 or 4 slices through the acellular dermal matrix (ADM) pocket.\u003c/p\u003e\n\u003cp\u003eB. The software automatically segments the ADM pocket volume.\u003c/p\u003e","description":"","filename":"figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3277351/v1/04ae34bd04feaafbf105dbbf.jpg"},{"id":42669528,"identity":"26bf4493-0faf-4776-ac84-c87c4b341a5e","added_by":"auto","created_at":"2023-09-05 22:51:13","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":443423,"visible":true,"origin":"","legend":"\u003cp\u003eA 57-year-old woman underwent breast conserving surgery (BCS) with ADM in the left breast. The patient refused adjuvant chemotherapy and radiotherapy, and recurrence was detected after 6 months.\u003c/p\u003e\n\u003cp\u003eA. Mammography shows grouped amorphous and pleomorphic microcalcifications (white arrow) adjacent to the BCS scar.\u003c/p\u003e\n\u003cp\u003eB. Ultrasonography shows ill-defined heterogeneous hypoechoic parenchymal lesions with hyperechoic dots representing calcifications (white arrow) in the upper inner quadrant of the left breast. US-guided core needle biopsy was performed.\u003c/p\u003e\n\u003cp\u003eC. A subtracted two-minute sequence of MRI shows non-mass-like enhancement of the lesion (white arrow) in adjacent to the ADM pocket (empty arrows).\u003c/p\u003e\n\u003cp\u003eD. Chest CT shows non-mass-like enhancement of the lesion (white arrow) in adjacent to the ADM pocket (empty arrows).\u003c/p\u003e","description":"","filename":"figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3277351/v1/9c79ce4ffaf85c418c0ca9a7.jpg"},{"id":42669526,"identity":"1e634ea3-baee-449b-a2d8-e4d304d4742c","added_by":"auto","created_at":"2023-09-05 22:51:13","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":89326,"visible":true,"origin":"","legend":"\u003cp\u003eCorrelation between volume changes and time\u003c/p\u003e","description":"","filename":"figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3277351/v1/e14cf01fc802bb941f8e5f2c.jpg"},{"id":42669529,"identity":"fa810c78-44d7-4e08-9555-7c53f010a502","added_by":"auto","created_at":"2023-09-05 22:51:13","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":179725,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 1E. Patients in volume analysis\u003c/p\u003e","description":"","filename":"figure1E.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3277351/v1/def336242d03ee42609c0e66.jpg"},{"id":44027554,"identity":"9c128d89-71d9-4fd7-89ae-3cb874774f08","added_by":"auto","created_at":"2023-10-03 15:22:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":505661,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3277351/v1/b019f9a3-6e7d-47d8-919e-cce084e302e8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical efficacy and safety of acellular dermal matrix as a method of volume replacement after breast-conserving surgery","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBreast conserving surgery (BCS) is the one of the most common surgical procedures in South Korea. BCS is an oncologically safe method that aims to preserve the breast [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. During BCS, in addition to removing the tumor with adequate margins, many surgeons are concerned with the cosmetic aspect, namely, maintaining the shape of the breast [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Oncoplastic surgery is a new approach that addresses these two issues. Volume displacement is a type of oncoplastic surgery in which the defect is filled using the surrounding breast tissue. However, because Korean women have relatively small breasts, achieving satisfactory cosmetic results using the volume displacement method is difficult [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In addition, this method is associated with long scars and a long recovery period [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAnother oncoplastic surgery method to fill the defect after BCS is volume replacement, which can be performed using an acellular dermal matrix (ADM) to replace the volume. ADM is derived from human skin tissue that has undergone decellularization[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This process removes cells and immunogenic substances to prevent immune rejection and inflammation after transplantation, and the remaining scaffold of connective tissue serves as a matrix for re-epithelialization, neovascularization, and fibroblast infiltration[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. ADMs are widely used for implant-based breast reconstruction to supplement cosmesis, and their safety and effectiveness have been demonstrated[\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe use of the ADM as a volume filler in BCS is currently being explored, and there are few reports on the effectiveness of this method for BCS[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Paik et al. and Gwak et al. used ADMs in breast cancer patients undergoing BCS and showed that this method is easy and safe with satisfactory cosmetic outcomes[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, to the best of our knowledge, the safety and efficacy of breast volume maintenance have not been evaluated quantitatively during surveillance follow-up. In this study, the outcomes of the inserted ADM were evaluated quantitatively using computed tomography (CT) scan volume analysis, and the complications and recurrence of cancer were evaluated during surveillance follow-up.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThe study protocol was approved by the Institutional Review Board of Ulsan University Hospital (IRB number: 2023-01-003-001).\u003c/p\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003ePatients\u003c/h2\u003e\n\u003cp\u003eA total of 137 patients who underwent BCS in a single institution between October 2019 and October 2021 were retrospectively enrolled. Patients who were likely to develop a deformity of the breast contour after BCS were included. All patients provided consent regarding the insertion of an ADM. Regardless of tumor size and location, patients who underwent insertion of a 5 \u0026times; 7 cm sheet-type ADM were inserted. Demographic data, histologic type, tumor stage, tumor location, and adjuvant radiotherapy were recorded.\u003c/p\u003e\n\u003cp\u003eDuring the surveillance follow-up period until December 2022, complications associated with the operation were recorded. Lesions assessed as Breast Imaging Reporting and Data System (BI-RADS) Category 4A[\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e] or higher that were detected on surveillance imaging follow-up studies, and the results of pathological analysis of these lesions, were reported.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n\u003ch2\u003eSurgical technique\u003c/h2\u003e\n\u003cp\u003eA 5 \u0026times; 7 cm sheet-type ADM (CGderm\u0026reg;, CGBIO Inc., Seongnam, Korea) was used. One sheet was used per patient.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003ePatients received intravenous cephalosporin as preoperative and postoperative antibiotics, which is the protocol used for all patients undergoing breast cancer surgery.\u003c/p\u003e\n\u003cp\u003eBefore surgery, the ADM was immersed in sterile normal saline. The size of the incision was determined according to the location and size of the tumor, and the mass was excised to achieve negative margins. In the excision cavity, the breast tissue was resected for frozen biopsy. After confirming negative results of the frozen biopsy, the fibroglandular tissue was undermined from the skin to reposition the breast tissue. First, tissue reapproximation was used to close the glandular defect left after tumor excision. Then, the ADM was inserted into the area of the defect cavity that could not be closed; if necessary, it was folded once to fit the size of the defect. The ADM was fixed to the surrounding tissue using Vicryl 2\u0026thinsp;\u0026minus;\u0026thinsp;0, and the area was examined to ensure that there was no dimpling or convex rise of the skin. To protect the ADM, the subcutaneous fat overlying the ADM was approximated and the skin was closed.\u003c/p\u003e\n\u003cp\u003eA Jackson-Pratt (JP) drain was inserted for seroma drainage, if necessary, as determined by the surgeon. The JP drain was removed after 2\u0026ndash;3 days when the drain volume was \u0026lt;\u0026thinsp;30 cc.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n\u003ch2\u003eADM volume analysis\u003c/h2\u003e\n\u003cp\u003eVolumetric analyses were performed in patients who underwent CT scans of the chest region at 1 and 12 months after the operation. Patients with the following complications were excluded from the study: infection, postoperative fluid collection, and air collection.\u003c/p\u003e\n\u003cp\u003eVolumetric analyses were performed using Siemens syngo.via VB 30B software (Siemens Healthcare, Erlangen, Germany). Image analysis was performed by a breast radiologist with 10 years of experience and a breast surgeon with 5 years of experience.\u003c/p\u003e\n\u003cp\u003eADM pockets were identified and delineated every 3\u0026ndash;4 image slices on trans-axial pre-contrast CT scanning images. The software calculates the volume semiautomatically following the line defined by the radiologist. This analysis was performed using CT images obtained at 1 month and at the last CT scan after surgery (Fig.\u0026nbsp;1).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n\u003ch2\u003eStatistical analysis\u003c/h2\u003e\n\u003cp\u003eStatistical analysis was performed using SPSS software (version 21.0; IBM Corp, Armonk, NY, USA). A P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. The ADM volume was compared between the first and last CT scans using the paired t-test, and the association between ADM volume changes and postoperative elapsed time was assessed using Pearson\u0026rsquo;s correlation analysis.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe characteristics of the 137 patients included in the study are shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. The mean age was 51.4 years, weight was 59.0 kg, and BMI was 23.3 kg/m\u003csup\u003e2\u003c/sup\u003e. Tumor location was the upper outer quadrant in 56 patients, upper inner quadrant in 35 patients, lower outer quadrant in 30 patients, lower inner quadrant in eight patients, and central location in nine patients. Of 137 patients, 132 patients underwent adjuvant radiation therapy.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eCharacteristics of included patients\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCharacteristics\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge (years)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e51.4\u0026thinsp;\u0026plusmn;\u0026thinsp;7.6\u003c/p\u003e\n\u003cp\u003e(27\u0026ndash;69)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHeight (cm)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e159\u0026thinsp;\u0026plusmn;\u0026thinsp;4.97\u003c/p\u003e\n\u003cp\u003e(147\u0026ndash;169)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWeight (Kg)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e59.0\u0026thinsp;\u0026plusmn;\u0026thinsp;8.37\u003c/p\u003e\n\u003cp\u003e(35.0-84.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.11\u003c/p\u003e\n\u003cp\u003e(15.3\u0026ndash;31.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eT stage\u003c/p\u003e\n\u003cp\u003eypT0\u003c/p\u003e\n\u003cp\u003epTis/ypTis\u003c/p\u003e\n\u003cp\u003epT1/ypT1\u003c/p\u003e\n\u003cp\u003epT2/ypT2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003cp\u003e30(29/1)\u003c/p\u003e\n\u003cp\u003e72(71/1)\u003c/p\u003e\n\u003cp\u003e31(29/2)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePathology\u003c/p\u003e\n\u003cp\u003eDCIS\u003c/p\u003e\n\u003cp\u003eIDC\u003c/p\u003e\n\u003cp\u003eILC\u003c/p\u003e\n\u003cp\u003eOthers\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e29\u003c/p\u003e\n\u003cp\u003e99\u003c/p\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLocation\u003c/p\u003e\n\u003cp\u003eUpper outer quadrant (UO)\u003c/p\u003e\n\u003cp\u003eUpper inner quadrant (UI)\u003c/p\u003e\n\u003cp\u003eLower outer quadrant (LO)\u003c/p\u003e\n\u003cp\u003eLower inner quadrant (LI)\u003c/p\u003e\n\u003cp\u003eCentral*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e56\u003c/p\u003e\n\u003cp\u003e35\u003c/p\u003e\n\u003cp\u003e30\u003c/p\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAdjuvant radiotherapy\u003c/p\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e132\u003c/p\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (Range) pT\u0026thinsp;=\u0026thinsp;pathologic T staging; ypT\u0026thinsp;=\u0026thinsp;pathologic T staging following neoadjuvant chemotherapy; DCIS\u0026thinsp;=\u0026thinsp;ductal carcinoma in situ; IDC\u0026thinsp;=\u0026thinsp;invasive ductal carcinoma; ILC\u0026thinsp;=\u0026thinsp;invasive lobular carcinoma.\u003c/p\u003e\n\u003cp\u003e* Central was defined as cancer within 1 cm of nipple or subareolar lesion\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe complications of the use of ADM included seroma, which was the most common complication, in ten patients, hematoma in five patients, and redness in one patient at the first outpatient clinic visit. There were no major complications requiring reoperation, and none of the patient required removal of the ADM.\u003c/p\u003e\n\u003cp\u003eSeventeen patients underwent biopsy because a Category 4A lesion was detected in the ipsilateral breast during the surveillance follow-up (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). In these patients, most of the biopsy results were benign, and one patient was diagnosed with a recurrence. This patient refused adjuvant radiotherapy and chemotherapy after the first surgery and relapsed after 6 months. Suspicious findings on mammography and ultrasonography were noted, and a more definite lesion was observed on breast magnetic resonance imaging (MRI) (Fig.\u0026nbsp;2). No interval cancer was detected during the surveillance follow-up period.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eBiopsy on subsequent follow up examination\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eImaging modality\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePatient number\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePathology\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMammography\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUltrasonography\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMagnetic resonance imaging\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eComputed tomography\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFat necrosis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFibrocystic change\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFibrocystic change\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eStromal fibrosis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFat necrosis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eStromal fibrosis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFibrocystic change\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFibrocystic change\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eInterlobular fibrosis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eInterlobular fibrosis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eInterlobular fibrosis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFibrocystic change\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFibroadenoma\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eStromal fibrosis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFibrocystic change\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eInvasive ductal carcinoma\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eStromal fibrosis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eYes: The suspected lesion is visible in imaging modality.\u003c/p\u003e\n\u003cp\u003eNo: The suspected lesion is not visible in imaging modality.\u003c/p\u003e\n\u003cp\u003eA total of 67 patients were included in the volume analysis (Fig.\u0026nbsp;1e). The mean follow-up interval between CT scans was 574 days (range, 336\u0026ndash;1081 days). The average ADM volume was 12.80\u0026thinsp;\u0026plusmn;\u0026thinsp;2.48 cm\u003csup\u003e3\u003c/sup\u003e (6.5\u0026ndash;17.92) at the first CT scan and 10.15\u0026thinsp;\u0026plusmn;\u0026thinsp;2.95 cm\u003csup\u003e3\u003c/sup\u003e (3.22\u0026ndash;16.34) at the last CT scan. The mean ADM volume difference between the first and last CT scans was 2.65\u0026thinsp;\u0026plusmn;\u0026thinsp;2.20 cm\u003csup\u003e3\u003c/sup\u003e and the difference was statistically significant (p\u0026thinsp;=\u0026thinsp;0.000). The percentage difference between the first and last CT scans was 21.01\u0026thinsp;\u0026plusmn;\u0026thinsp;17.31%. There was a significant correlation between differences in volume and the number of days between the first and last CT scans (r\u0026thinsp;=\u0026thinsp;0.418, p\u0026thinsp;=\u0026thinsp;0.000) (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study quantitatively analyzed changes in ADM volume to determine the effectiveness of the inserted ADM after BCS. The volume decreased by a mean 2.67 cm\u003csup\u003e3\u003c/sup\u003e during a mean follow-up period of 574 days and continued to decrease over time. The reason for this decrease has been explained in several studies. Qing-Qing Qiu et al.[\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e] reported that E-beam irradiation sterilization cuts the collagen matrix of the ADM. Other studies also report that the gamma and E-beam irradiation used for sterilization accelerate the rate of collagen fiber degradation and fragmentation in the ADM[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e]. The increased rate of degradation and fragmentation compromises the tensile strength of the ADM[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e]. Since most patients who have undergone BCS surgery undergo radiation therapy, it is accepted that some shrinkage of the ADM will occur.\u003c/p\u003e\n\u003cp\u003eAlthough a decrease in ADM volume was observed, the decrease was only about 2\u0026ndash;3 cm\u003csup\u003e3\u003c/sup\u003e, which is small and unlikely to have a significant effect on the volume of the breast. In addition, breast volume is reduced in patients who received radiation therapy after conventional BCS. Cho et al. and Chung et al. reported a 17.6% decrease in the volume of the lumpectomy cavity, and a 5% decrease in the tumor bed, in patients who received radiation therapy[\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e]. Considering the decrease in breast volume after radiation therapy, it is unlikely that a decrease in the volume of the ADM would lead to a significant effect on cosmesis. However, since we observed a decrease in the volume of the ADM over time, future evaluation should extend over a longer period.\u003c/p\u003e\n\u003cp\u003eThe use of ADMs is associated with potential complications. In this study, 16 patients had minor complications, most of which were seroma (as reported in other studies[\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e]). The incidence of seroma in patients undergoing conventional BCS is 9\u0026ndash;11%[\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e], indicating that the use of an ADM in this study was not associated with an increased risk of complications. One patient had a suspected infection, which improved after 3 days of oral antibiotics. None of the patients required removal of the ADM. Consistent with previous studies, the present results indicate that this is a safe method.\u003c/p\u003e\n\u003cp\u003eDuring postoperative surveillance using breast ultrasonography (US), visibility may be limited by the fibrogenetic action induced by the ADM[\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e]. The inserted ADMs appear as well circumscribed masses with a density similar to that of fibroglandular tissue on mammography, and iso- or hypoechoic on US; therefore, ADMs may make detecting cancer recurrence more difficult[\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e]. The patients included in this study were examined by breast MRI and breast US according to the follow-up protocol of our hospital. The surveillance examination detected a Category 4a lesion in the ipsilateral breast in 17 patients, and one patient was diagnosed with a recurrence. During the follow-up period, there was no interval cancer in the included patients. An et al. reported that breast MRI is more effective than mammography or US for the detection of ipsilateral local tumor recurrence in patients who undergo BCS with ADMs despite the postoperative changes caused by ADMs[\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eThis study had several limitations. First, it was a retrospective, single-center study. Second, all patients included in this study were not applied, and only 67 of the patients included in this study underwent volume analysis. Third, subjective aesthetic or visual satisfaction was not evaluated because there are no validated tools and no consensus on how the evaluation should be performed.\u003c/p\u003e\n\u003cp\u003eIn conclusion, insertion of ADM after BCS is an effective and safe method to fill the volume defect, despite the slight change in volume of ADM. In addition, the ADM does not interfere with postoperative surveillance.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the Institutional Review Board of Ulsan University Hospital (IRB number: 2023-01-003-001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBang, Kwon and Kim designed the study, wrote the manuscript, and collected the corresponding datasets. Kwon, Ko and Byon drew the figures as well as tables. Bang and Kim supervised the whole project and edited the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData cannot be shared openly but are available on request from authors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKang SY, Lee SB, Kim YS, Kim Z, Kim HY, Kim HJ, et al. Breast cancer statistics in Korea, 2018. J Breast Cancer. 2021;24:123\u0026ndash;37. \u003c/li\u003e\n\u003cli\u003eMasetti R, Pirulli PG, Magno S, Franceschini G, Chiesa F, Antinori A. Oncoplastic techniques in the conservative surgical treatment of breast cancer. Breast Cancer. 2000;7:276\u0026ndash;80. \u003c/li\u003e\n\u003cli\u003eKim SY, Ph D. Comparison of wound closure using ADM with primary wound closure after BCS in breast cancer patients. 2022;10:12\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eYang JD, Lee JW, Kim WW, Jung JH, Park HY. Oncoplastic surgical techniques for personalized breast conserving surgery in breast cancer patient with small to moderate sized breast. J Breast Cancer. 2011;14:253\u0026ndash;61. \u003c/li\u003e\n\u003cli\u003eClough KB, Kaufman GJ, Nos C, Buccimazza I, Sarfati IM. Improving breast cancer surgery: A classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol. 2010;17:1375\u0026ndash;91. \u003c/li\u003e\n\u003cli\u003eLee JH, Kim HG, Lee WJ. Characterization and tissue incorporation of cross-linked human acellular dermal matrix. Biomaterials [Internet]. 2015;44:195\u0026ndash;205. Available from: http://dx.doi.org/10.1016/j.biomaterials.2014.12.004\u003c/li\u003e\n\u003cli\u003eSorkin M, Qi J, Kim HM, Hamill JB, Kozlow JH, Pusic AL, et al. Acellular Dermal Matrix in Immediate Expander/Implant Breast Reconstruction: A Multicenter Assessment of Risks and Benefits. Plast Reconstr Surg. 2017;140:1091\u0026ndash;100. \u003c/li\u003e\n\u003cli\u003eHallberg H, Rafnsdottir S, Selvaggi G, Strandell A, Samuelsson O, Stadig I, et al. Benefits and risks with acellular dermal matrix (ADM) and mesh support in immediate breast reconstruction: a systematic review and meta-analysis. J Plast Surg Hand Surg [Internet]. 2018;52:130\u0026ndash;47. Available from: https://doi.org/10.1080/2000656X.2017.1419141\u003c/li\u003e\n\u003cli\u003eCabalag MS, Rostek M, Miller GS, Chae MP, Quinn T, Rozen WM, et al. Alloplastic adjuncts in breast reconstruction. Gland Surg. 2016;5:158\u0026ndash;73. \u003c/li\u003e\n\u003cli\u003eAn J, Kwon H, Lim W, Moon BI, Paik NS. The comparison of breast reconstruction using two types of acellular dermal matrix after breast-conserving surgery. J Clin Med. 2021;10. \u003c/li\u003e\n\u003cli\u003eGwak H, Jeon YW, Lim ST, Park SY, Suh YJ. Volume replacement with diced acellular dermal matrix in oncoplastic breast-conserving surgery: A prospective single-center experience. World J Surg Oncol. 2020;18:1\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eAcr. 2013 ACR BI-RADS Atlas: Breast Imaging Reporting and Data System. \u003c/li\u003e\n\u003cli\u003ePomerleau J, Connor J. Terminal Sterilization of Biological Tissue Matrix Using Supercritical CO 2 Qing-Qing. \u003c/li\u003e\n\u003cli\u003eNilsen TJ, Dasgupta A, Huang YC, Wilson H, Chnari E. Do Processing Methods Make a Difference in Acellular Dermal Matrix Properties? Aesthet Surg J. 2016;36:S7\u0026ndash;22. \u003c/li\u003e\n\u003cli\u003eLewandowska H, Eljaszewicz A, Poplawska I, Tynecka M, Walewska A, Grubczak K, et al. Optimization of novel human acellular dermal dressing sterilization for routine use in clinical practice. Int J Mol Sci. 2021;22. \u003c/li\u003e\n\u003cli\u003eCho H, Kim C. Volumetric changes in the lumpectomy cavity during whole breast irradiation after breast conserving surgery. Radiat Oncol J. 2011;29:277.\u003c/li\u003e\n\u003cli\u003eChung MJ, Suh YJ, Lee HC, Kang DG, Kim EJ, Kim SH, et al. Tumor bed volumetric changes during breast irradiation for the patients with breast cancer. Radiat Oncol J. 2013;31:228\u0026ndash;33. \u003c/li\u003e\n\u003cli\u003eKim H Il, Kim BS, Kim YS, Yi HS, Park JH, Choi JH, et al. Review of 107 Oncoplastic Surgeries Using an Acellular Dermal Matrix with the Round Block Technique. J Clin Med. 2022;11. \u003c/li\u003e\n\u003cli\u003eIsraeli Ben-Noon H, Farber N, Weissman O, Tessone A, Stavrou D, Shabtai M, et al. The effect of acellular dermal matrix on drain secretions after immediate prosthetic breast reconstruction. J Plast Surg Hand Surg. 2013;47:308\u0026ndash;12. \u003c/li\u003e\n\u003cli\u003eGonzalez EA, Saltzstein EC, Riedner CS, Nelson BK. Seroma formation following breast cancer surgery. Breast Journal. 2003;9:385\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eMohamedahmed AYY, Zaman S, Zafar S, Laroiya I, Iqbal J, Tan MLH, et al. Comparison of surgical and oncological outcomes between oncoplastic breast-conserving surgery versus conventional breast-conserving surgery for treatment of breast cancer: A systematic review and meta-analysis of 31 studies. Surg Oncol. Elsevier Ltd; 2022. \u003c/li\u003e\n\u003cli\u003eLee J, Yang JD, Lee JW, Li J, Jung JH, Kim WW, et al. Acellular dermal matrix combined with oxidized regenerated cellulose for partial breast reconstruction: Two case reports. Medicine. 2020;99:e21217.\u003c/li\u003e\n\u003cli\u003eFranceschini G. Internal surgical use of biodegradable carbohydrate polymers. Warning for a conscious and proper use of oxidized regenerated cellulose. Carbohydr Polym. Elsevier Ltd; 2019. p. 213\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eFranceschini G, Visconti G, Sanchez AM, Di Leone A, Salgarello M, Masetti R. Oxidized regenerated cellulose in breast surgery: Experimental model. Journal of Surgical Research. 2015;198:237\u0026ndash;44. \u003c/li\u003e\n\u003cli\u003eKim MY, Suh YJ, An YY. Imaging surveillance for the detection of ipsilateral local tumor recurrence in patients who underwent oncoplastic breast-conserving surgery with acellular dermal matrix: abbreviated MRI versus conventional mammography and ultrasonography. World J Surg Oncol [Internet]. 2021;19:1\u0026ndash;10. Available from: https://doi.org/10.1186/s12957-021-02403-2\u003c/li\u003e\n\u003cli\u003eLee HS, Kim KS. Follow-Up after Volume Replacement Using Acellular Dermal Matrix in Oncoplastic Breast-Conserving Surgery. Clinical Ultrasound. 2022;7:54\u0026ndash;7. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Acellular dermal matrix, Breast conserving surgery, Breast cancer","lastPublishedDoi":"10.21203/rs.3.rs-3277351/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3277351/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe cosmetic outcome of breast conserving surgery (BCS) has recently gained attention, and surgeons are exploring the use of the acellular dermal matrix (ADM), a safe and effective method of breast reconstruction. This study evaluated the safety and effectiveness of the sheet-type ADM for reconstruction after BCS.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eThe study included 137 patients who underwent BCS using ADM in a single center between October 2019 and October 2021. During surgery, a sheet-type ADM was folded and inserted according to the size and shape of the excised defect. Complications and cancer recurrence were evaluated during surveillance follow-up, and maintenance of the inserted ADM was evaluated quantitatively using volume analysis on CT scan.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOf the 137 patients, 16 had minor complications and 17 underwent biopsy during the surveillance period. One patient was diagnosed with recurrence. The volume of the ADM was measured in 67 patients, and the mean volume difference between the first and last CT scans was 2.65\u0026thinsp;\u0026plusmn;\u0026thinsp;2.20 cm\u003csup\u003e3\u003c/sup\u003e (p\u0026thinsp;=\u0026thinsp;0.000).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eInsertion of ADM is an effective and safe method to fill the volume defect after BCS despite the slight volume change, and it does not interfere with postoperative surveillance.\u003c/p\u003e","manuscriptTitle":"Clinical efficacy and safety of acellular dermal matrix as a method of volume replacement after breast-conserving surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-09-05 22:51:08","doi":"10.21203/rs.3.rs-3277351/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0936fb8e-b10e-488a-8842-3b84a4fd1c4a","owner":[],"postedDate":"September 5th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-10-03T15:14:34+00:00","versionOfRecord":[],"versionCreatedAt":"2023-09-05 22:51:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3277351","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3277351","identity":"rs-3277351","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}