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Background: Acellular dermal matrix (ADM) is commonly used in breast reconstruction to allow for quicker expansion and better coverage and definition of the lower pole of the breast. This study was performed to analyze the risk of complications associated with the use of ADM in immediate staged implant based breast reconstruction and to subsequently develop guidelines for its use.
Methods: After obtaining a IRB approval, a retrospective analysis of 685 consecutive staged implant based breast reconstructions at a single institution over a three-year period was conducted. The reconstructions were divided into two groups: those using ADM and those not using ADM. The demographic information, preoperative breast size, use of methylene blue dye, the need for lymph node dissection, breast cancer stage, use of adjuvunct/neoadjuvunct chemotherapy and radiation, history of recent and remote breast surgery, and complications were analyzed in comparison.
Results: A total of 480 patients underwent 747 immediate staged implant based breast reconstructions, 213 unilateral and 267 bilateral. 558 reconstructions were performed using ADM and 189 were performed without the use of ADM. The groups had similar characteristics when compared, including average age, BMI, percentage of small and large breasted women, cancer stage, medical co-morbidities, and smoking history. Major complications were significantly increased in the ADM group when compared to the group that did not receive ADM (17.6% vs 7.9% p<0.01). These complications included: Infection requiring only IV antibiotics (6.6 % vs. 3.7, p <0.01), Flap necrosis requiring excision (6.5% vs. 1.1 %, p <0.01), and explantation of the tissue expander (7.5% vs. 3.1%, p <0.01).
Conclusions: The use of ADM in immediate breast cancer reconstruction is associated with a significant increase in major complications. Therefore, ADM should be used sparingly in selected patients. Indications for use include: patients undergoing single-stage permanent implant reconstruction or patients with inadequate coverage of the tissue expander with local muscles. The surface area and volume of ADM used should also be kept to a minimum.