|89th Annual Meeting Abstracts
Post-operative complications in implant-based breast reconstruction using acellular dermal matrix.
Allen Liu, MD1, Richard Reish, MD1, Huang-Kai Kao, MD2, Charles Hergrueter, MD1, Lifei Guo, MD, PhD1.
1Brigham and Women's Hospital, Boston, MA, USA, 2Chang Gung Memorial Hospital, Taipei, Taiwan.
The use of acellular dermal matrix has become commonplace as a useful adjunct in tissue expander/implant breast reconstruction. It provides support for the lower pole and renders the elevation the serratus anterior or pectoralis minor muscles unnecessary for coverage of the inferolateral portion of the tissue-expander or implant. Several reports have raised concerns that acellular dermal matrix may lead to increased complication rates, including infection and seroma formation. No large-scale study has been reported that compares implant-based breast reconstruction using acellular dermal matrix with implant-based breast reconstruction alone performed within the same period at a single tertiary center. Our study was conducted to determine whether the use of acellular dermal matrix in implant-based breast reconstruction is associated with higher rate of post-operative complications at a tertiary center.
A retrospective review was performed of consecutive immediate implant-based breast reconstruction over a five and a half year period at the Brigham and Women’s Hospital. A total of 476 mastectomies were reconstructed immediately using tissue expanders or implants. These were divided into two groups: tissue expander or implant-based reconstruction using acellular dermal matrix and tissue expander or implant-based reconstruction alone. Data were collected on patient co-morbidities, smoking habit, adjuvant therapy, use of tumescence during mastectomy, and complications for analysis.
From January 2004 to June 2009, 345 patients underwent immediate implant-based breast reconstruction after mastectomy at the Brigham and Women’s Hospital. A total of 476 tissue expanders/implants were placed, of which 266 breasts were reconstructed using tissue expanders or implants with acellular dermal matrix, while 210 breasts were reconstructed using tissue expanders or implants alone. The rate of seroma formation that required aspiration and drainage was 7.1% in the acellular dermal matrix group, and 2.8% in the control group (p=0.037). The rate of major infection that required tissue expander or implant removal was 4.9% in the acellular dermal matrix group and 2.9% in the control group (p=0.347). The rate of minor infection that was adequately treated with intravenous antibiotics was 1.9% in the acellular dermal matrix group and 0% in the control group (p=0.069). When all surgical complications (including infections, skin necrosis, seroma, and hematoma) were examined in a multivariate model, we found that acellular dermal matrix, BMI, and the use of tumescent solution during mastectomy are significant predictors of post-operative complications.
Acellular dermal matrix is a useful adjunct in implant-based breast reconstruction. Even though it renders the need for elevating the serratus anterior or pectoralis minor muscles unnecessary for inferolateral pole coverage, it is associated with a higher rate of post-operative seroma formation and overall surgical complications, when compared to implant-based breast reconstruction without acellular dermal matrix. The use of acellular dermal matrix, however, does NOT significantly increase the risk of infection. To optimize the outcome of implant-based breast reconstruction using acellular dermal matrix, one must be careful with patient selection and follow the patient closely in the immediate post-operative period.