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Analysis of Clinically Significant Seroma Formation in Breast Reconstruction using Acellular Dermal Grafts
Brett Michelotti, MD, Sebastian Brooke, MD, John Mesa, MD, Kurtis Moyer, MD, Donald Mackay, MD, John Potochny, MD.
Milton S. Hershey Medical Center, Hershey, PA, USA.

Background: Surgeons commonly use acellular dermal matrix (ADM) to support the lower pole of the breast in tissue expander-based breast reconstruction (TEBR). With a dramatic rise in the number of tissue expander-based reconstructions, we have seen an increase in ADM-specific complications. In a prior review of outcomes following TEBR using ADM, we identified no difference in infectious complications requiring an additional intervention between breast reconstructions with and without ADM. Seroma formation is another common complication following breast reconstruction using ADM. In this study, we aimed to evaluate clinically significant seroma formation - defined by the need for a drainage procedure - to determine if there was a difference in prevalence between product types: Alloderm, DermaMatrix, and Flex HD.
Methods: This was a retrospective review of consecutive patients who underwent TEBR at a single institution. Exclusion criteria consisted of prior major breast surgery or inadequate postoperative documentation. The total number of reconstructed breasts was separated into four groups according to the product type: Alloderm (AL), DermaMatrix (DM), FlexHD (FHD), or no ADM. Demographic information was obtained in addition to the use of chemotherapy, radiation, or tobacco exposure. We identified the total number of clinically apparent seromas as well as the number of clinically significant seromas requiring a drainage procedure. Type of drainage procedure, office-based drainage vs. OR drainage, seroma recurrence and drainage complications were reviewed and the groups were compared statistically.
Results: In total, we identified 284 consecutive tissue expander-based reconstructions. Age, BMI, exposure to radiation or chemotherapy and tobacco use were not statistically different between groups. Overall, there were 27 clinically apparent seromas in 284 reconstructed breasts (9.5%). We compared the number of patients with seromas requiring drainage between all groups - Alloderm 3%(CI:0-13%), DermaMatrix 4%(CI:0-7%), FlexHD 10%(CI:2-17%), no ADM 2%(CI:0-5%) - which did not reach statistical significance (p=0.20). When comparing the total seroma rate between different types of ADM there was a trend toward more total seromas in the FlexHD group (p=0.17), but when comparing the number of seromas requiring drainage between ADM types, this trend was less apparent (p=0.26). The vast majority of seromas were drained in the office and there were two tissue expander punctures requiring removal.
Discussion: With the current trend in breast surgery favoring the use of tissue expander-based breast reconstruction, it is important to review the safety and efficacy of acellular dermal grafts. Our review suggests that there is no difference in total seroma formation - with or without ADM - or in those seromas requiring a drainage procedure. Though there was a trend toward more seromas in the Flex HD group as compared to the other ADM types, this was not statistically significant.
Conclusion: There is no difference in clinically significant seroma formation between AL, DM, FHD and no ADM.


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