Comparing Cortiva Silhouette to AlloDerm for Use in Prepectoral Two-stage Prosthetic Breast Reconstruction.

Background: The use of acellular dermal matrices (ADMs) in implant-based breast reconstruction has become increasingly routine during the past 20 years. ADMs improve soft-tissue support, facilitate greater tissue expander (TE) fill volumes, and reduce rates of capsular contracture. As the ADM market continues to grow, outcomes studies are necessary to assess the risks and benefits of each product. In this study, we compare the performance of Cortiva Silhouette, the thinnest ADM widely available, to AlloDerm, commonly considered the industry standard. Methods: We performed a retrospective review of 178 consecutive two-stage prosthetic breast reconstructions performed by the senior author. In every case, either Cortiva or AlloDerm was used to provide soft-tissue support during TE placement. Subjects were divided into Cortiva and AlloDerm cohorts and compared across patient characteristics and reconstructive outcomes variables. Results: During the study period, AlloDerm was used in 116 reconstructions; Cortiva was used in 62. After propensity score matching (62 AlloDerm, 62 Cortiva), Cortiva was associated with greater intraoperative and final TE fill volumes, as well as larger silicone implants. Cortiva was also associated with fewer complications overall, and fewer instances of mastectomy skin necrosis, delayed wound healing, and seroma. Conclusions: Cortiva Silhouette is noninferior to AlloDerm in terms of safety and providing soft-tissue support in prepectoral two-stage implant-based breast reconstruction. In this study, Cortiva supported greater TE fill volumes and larger silicone implants relative to AlloDerm and was associated with fewer complications.