Comparing Cortiva Silhouette to AlloDerm for use in Prepectoral Two-Stage Prosthetic Breast Reconstruction

Introduction: The use of acellular dermal matrices (ADMs) in implant-based breast reconstruction has become increasingly routine over the past 20 years. ADMs improve soft-tissue support, facilitate greater tissue expander (TE) fill volumes, and reduce rates of capsular contracture. In prepectoral breast reconstruction, ADM is critical for achieving proper implant positioning and full anterior coverage of the implant in a subcutaneous plane. 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. Relative to AlloDerm, Cortiva was associated with greater intra-operative and final TE fill volumes and facilitated the use of larger implants (523.1 ± 151.8 versus 461.4 ± 115.4 mL; p = 0.005). AlloDerm was associated with a greater incidence of any complication (28.4% versus 11.3%; p = 0.009).  

Conclusions: Cortiva Silhouette appears to be non-inferior to AlloDerm in terms of safety and cost. The unique structural properties of Cortiva may facilitate larger implant volumes compared to AlloDerm.