Immediate Implant-Based Breast Reconstruction with Acellular Dermal Matrix: A Comparison of Sterile and Aseptic AlloDerm in 2039 Consecutive Cases.

Abstract

BACKGROUND:

Sterile ready-to-use acellular dermal matrix, introduced as an alternative to aseptic freeze-dried acellular dermal matrix for implant-based breast reconstruction, has been investigated in a limited number of studies. This study compared outcomes in implant-based breast reconstruction with ready-to-use and freeze-dried acellular dermal matrix.

METHODS:

The authors analyzed patients undergoing implant-based breast reconstruction with either freeze-dried or ready-to-use acellular dermal matrix, including demographics, clinical variables, and outcomes. An a priori power analysis was performed and logistic regression modeling was used to quantify the effect of acellular dermal matrix on outcomes while controlling for potential confounders.

RESULTS:

A total of 1285 consecutive patients undergoing 2039 immediate prosthetic breast reconstructions constituted the population: 612 (n = 910 breasts) with freeze-dried matrix and 673 (n = 1129 breasts) with ready-to-use acellular dermal matrix. The freeze-dried matrix cohort had a significantly higher rate of explantation compared with the ready-to-use matrix cohort (18.0 percent versus 12.0 percent; p = 0.0036), but surgical-site infection, wound dehiscence, mastectomy flap necrosis, seroma, and hematoma did not differ significantly between groups. On multivariate regression, patients undergoing reconstruction with freeze-dried matrix, compared to ready-to-use matrix, did not have higher odds of experiencing surgical-site infections (OR, 1.064; p = 0.7455), but did have higher odds of explantation (OR, 1.570; p = 0.0161). Tobacco use (OR, 2.809; p = 0.0002) and body mass index (OR, 1.054; p < 0.0001) were also independent predictors of explantation.

CONCLUSION:

Immediate implant-based breast reconstruction with sterile ready-to-use acellular dermal matrix has a comparable overall safety profile and a lower rate of prosthetic explantations compared with aseptic freeze-dried acellular dermal matrix.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.

• Authors: Rajiv P Parikh, Gabriella M Brown, Ketan Sharma, Yan Yan, Terence M Myckatyn
• Journal: Plastic and reconstructive surgery (Plast Reconstr Surg) Vol. 142 Issue 6 Pg. 1401-1409 (12 2018) ISSN: 1529-4242 [Electronic] United States
• PMID: 30204676 (Publication Type: Comparative Study, Evaluation Study, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Topics

• Acellular Dermis (statistics & numerical data)
• Asepsis
• Breast Implantation (instrumentation, statistics & numerical data)
• Breast Implants (statistics & numerical data)
• Breast Neoplasms (surgery)
• Female
• Freeze Drying
• Humans
• Mastectomy (methods, statistics & numerical data)
• Middle Aged
• Nipples
• Organ Sparing Treatments (methods, statistics & numerical data)
• Postoperative Complications (etiology)
• Prospective Studies
• Prosthesis Design
• Retrospective Studies
• Sterilization
• Surgical Wound Infection (prevention & control)