|2009 Annual Meeting Abstracts
Implant-based Breast Reconstruction Using Acellular Dermal Matrix and the Risk of Post-operative Complications
Yoon S. Chun, M.D.1, Kapil Verma, B.A.2, Heather Rosen, M.D., M.P.H.3, Stuart R. Lipsitz, Ph.D.1, Donald Morris, M.D.2, Pardon R. Kenney, M.D.4, Elof Eriksson, M.D.1.
1Brigham and Women's Hospital, Boston, MA, USA, 2Harvard Medical School, Boston, MA, USA, 3Children's Hospital Boston, Boston, MA, USA, 4Faulkner Hospital, Boston, MA, USA.
Although implant-based breast reconstruction is simple, expeditious, and involves no donor site morbidity, the reconstruction outcome heavily relies on overlying soft tissue coverage and support. Acellular dermal matrix has been recently popularized as a useful adjunct to tissue expander or implant breast reconstruction given its ability to provide additional coverage and support for the inferior pole. This study was performed to assess the risk of post-operative complications associated with the use of acellular dermal matrix assisted tissue expander or implant-based breast reconstruction vs. tissue expander or implant-based reconstruction alone in the immediate breast reconstruction setting.
The authors performed a retrospective analysis of consecutive immediate breast reconstructions performed over a 6-year period in a single institution. A total of 372 mastectomies with reconstruction were divided into two groups for comparison: tissue expander or implant-based reconstruction using acellular dermal matrix vs. tissue expander or implant-based reconstruction alone. Demographic information, comorbidities, oncologic data, adjuvant therapy, and post-operative complications were collected for comparison.
A total of 252 patients underwent 132 unilateral and 120 bilateral immediate breast reconstructions totaling 372 immediate breast reconstructions. 241 reconstructions were performed using tissue expanders or implants with acellular dermal matrix, and 131 reconstructions were performed using tissue expanders or implants alone. The post-operative seroma rate was 12.5 % in the acellular dermal matrix group vs. 3.1 % in the control group (p = 0.003). The infection rate was 8.3 % in the acellular dermal matrix group vs. 0 % in the control group (p = 0.0017). The native breast skin flap necrosis rate was 20.3 % in the acellular dermal matrix group vs. 9.2 % in the control group (p = 0.0075).
Acellular dermal matrix has enhanced implant-based breast reconstruction and remains useful in immediate prosthetic breast reconstruction. However, it may be associated with higher rates of post-operative seroma and infection compared to implant-based breast reconstruction without the use of acellular dermal matrix . Careful selection of patients and post-operative management appears to be warranted to optimize overall reconstructive outcome.