Comparison of implant-based immediate breast reconstruction with and without acellular dermal matrix

  • Vardanian A
  • Clayton J
  • Roostaeian J
 et al. 
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Abstract

BACKGROUND: Acellular dermal matrix is frequently used in implant-based breast reconstruction to cover the inferior aspect of the breast pocket. Its performance profile remains equivocal. The authors studied whether adding it in implant-based immediate breast reconstruction improved outcomes when compared with non-acellular dermal matrix reconstruction. METHODS: Patients undergoing implant-based immediate breast reconstruction at a single academic medical center were evaluated. Aesthetic outcomes and postoperative complications were assessed and direct comparisons were made between acellular dermal matrix and non-acellular dermal matrix cohorts. RESULTS: A total of 203 patients underwent 337 immediate expander-based breast reconstructions [with acellular dermal matrix, n=208 (61.7 percent); without, n=129 (38.3 percent)]. Patient characteristics, including age at time of reconstruction (mean, 49+/-11 versus 47+/-10 years) and body mass index (mean, 23+/-5 versus 23+/-3 kg/m) were similar between groups (p>0.05). Complications occurred in one-third of patients (33.5 percent). In univariate analyses, acellular dermal matrix use had fewer overall complications (odds ratio, 0.61; 95 percent CI, 0.38 to 0.97). The incidences of seroma/hematoma (p=0.59), infection (p=0.31), and wound complications (p=0.26) did not differ. Aesthetic outcomes were higher in the acellular dermal matrix group. In multivariate logistic regression, acellular dermal matrix use was associated with less capsular contracture (odds ratio, 0.18; 95 percent CI, 0.08 to 0.43) and mechanical shift (odds ratio, 0.23; 95 percent CI, 0.06 to 0.78). CONCLUSIONS: Optimizing the inframammary fold with acellular dermal matrix creates a superior aesthetic result. Its use appears safe and is associated with less capsular contracture and mechanical shift and improvement in the inframammary fold appearance, without increasing postoperative complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Author-supplied keywords

  • *Breast Implants
  • *Collagen
  • *Surgical Flaps
  • Adult
  • Breast Implantation/adverse effects/methods
  • Breast Neoplasms/pathology/surgery
  • Cohort Studies
  • Esthetics
  • Female
  • Follow-Up Studies
  • Humans
  • Logistic Models
  • Mammaplasty/adverse effects/*methods
  • Mastectomy/*methods
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Postoperative Care/methods
  • Postoperative Complications/physiopathology
  • Retrospective Studies
  • Risk Assessment
  • Time Factors
  • Tissue Expansion/methods
  • Treatment Outcome
  • Wound Healing/physiology

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Authors

  • A J Vardanian

  • J L Clayton

  • J Roostaeian

  • V Shirvanian

  • A Da Lio

  • J E Lipa

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