Anterior Tenting vs. Wrapping Technique for Acellular Dermal Matrix in Breast Reconstruction under Post-mastectomy Radiotherapy in Rats

Abstract This study compares outcomes between anterior tenting and whole wrapping techniques in prepectoral breast reconstruction using ADM. Fifteen rats were divided into control, anterior tenting, and whole wrapping groups, each receiving two silicone implants. Only silicone implants were placed in the control group. The anterior surface of the implants was covered with ADM in the anterior tenting group, whereas the implants were fully wrapped with ADM in the whole wrapping group. Animals were irradiated on one side of the back three weeks postoperatively and sacrificed three months postoperatively. The range of change in tonometry values with or without irradiation in whole wrapping tended to be larger than that of anterior tenting (p < 0.05). The cellular capsule was significantly thinner on the side covered by ADM (p < 0.05). There were no significant differences observed in the other microscopic features of the cellular capsule. The microscopic analysis of ADM revealed significant increases in total capsule thickness and collagen density with radiation exposure, while a significant decrease was observed in ⍺-SMA positive area, CD3 positive cell counts and F4/80 positive area (p < 0.05). In patients with the possibility of adjuvant radiation therapy, the anterior tenting technique is recommended over whole wrapping.