Comparison of DermACELL™ and Braxon® in prepectoral implant-based breast reconstruction: Complication rates and clinical implications.
BACKGROUND Breast cancer remains the most common malignancy among women worldwide, with many patients undergoing mastectomy followed by implant-based reconstruction (IBR). Prepectoral IBR has gained popularity due to reduced postoperative pain and improved esthetic outcomes. This approach frequently utilizes acellular dermal matrices (ADMs), including DermACELL™ (human-derived, partial coverage) and Braxon® (porcine-derived, full-wrap), which differ in composition and surgical application. Evidence comparing their complication profiles remains inconclusive. This study aimed to compare postoperative outcomes between these two ADMs in prepectoral IBR. METHODS A retrospective review was conducted of patients who underwent prepectoral IBR with Braxon® or DermACELL™ between June 2022 and January 2026 at a single institution. Data collected included demographics, surgical characteristics, ADM type, adjuvant therapy, and postoperative complications. Groups were compared using univariable analyzes, and multivariable logistic regression was performed to adjust for confounders. RESULTS A total of 125 cases were included (58 Braxon®, 67 DermACELL™). Baseline demographics and operative characteristics were comparable. Differences were noted in antibiotic regimens and surgeon distribution. The overall complication rate was 37.6% (n=47), including 18.4% minor and 19.2% major complications. The most common complications were seroma (14.4%) and wound dehiscence (13.6%). Capsular contracture ≥ grade III occurred in 7.2%, and reoperation was required in 18.4% of cases. No significant differences were observed between groups in complication rates or timing. Reoperation was numerically higher in the Braxon® group than in the DermACELL™ group, although this did not reach statistical significance (p = 0.063). CONCLUSION No statistically significant differences in overall complications, major complications, or specific complications were observed between Braxon® and DermACELL™ in prepectoral IBR. Observed differences may reflect institutional practices, surgeon preference, or perioperative protocols rather than ADM-specific effects alone. Larger prospective studies are needed to evaluate long-term outcomes.