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A 10-year review of acellular dermal matrix vs. total muscle coverage for implant-based breast reconstruction
Eric Maiorino, J. Simon Ivey, Hamid Abdollahi, Sameer A. Patel, Neal S. Topham, Eric I. Chang
Fox Chase Cancer Center, Philadelphia, PA
Background:
Implant-based breast reconstruction is the most common method employed in the treatment of patients undergoing mastectomy. Acellular dermal matrix (ADM) has steadily become more popular in tissue expander/implant-based breast reconstruction. The aim of this study is to compare our series of total muscle (TM) coverage only patients with those receiving ADM.
Methods:
A retrospective review was performed of all patients undergoing tissue expander (TE) based breast reconstruction at a single academic cancer center between August 2002 and December 2012. Patients with and without ADM were compared and analyzed in terms of patient demographics, fill volumes, number of expansions, costs, and complications.
Results:
A total of 249 patients underwent mastectomy surgery with tissue expander based breast reconstruction during the study period. Three hundred seventy-six tissue expanders had TM coverage while sixty had ADM placed. The total overall complication rate was not significantly different between the ADM and TM groups (31.4% vs. 21.5%, p=0.198). Major complication rate was significantly higher in the ADM group (26.7% vs. 11.7%, p=.0039). Major complications included hematoma, tissue expander loss, implant loss due to infection, mastectomy skin flap necrosis requiring intervention, cellulitis requiring IV antibiotics, wound debridement, wound dehiscence, device exposure, and salvage with tissue flap. The mean initial fill volume was significantly lower in TM vs. ADM groups (54±47 vs. 167±139, p=0.00003) resulting in a higher number of expansions in patients with total muscle coverage (7.7 vs. 6.1, p=0.00076). The use of ADM added a mean cost of $2,192 for unilateral reconstruction and $3,513 for bilateral cases.
Conclusions:
Implant-based breast reconstruction has evolved with the advent of acellular dermal matrices. Although the total complication rate was similar for TM vs. ADM, the major complication rate was significantly higher with the use of ADM. The use of ADM allows increased initial fill volumes. The number of fills required to reach full expansion is higher with TM, however this only amounts to several more clinic visits. The use of ADM added considerable cost to the operation, especially in patients undergoing bilateral reconstruction. Total muscle coverage remains an excellent option for providing quality breast reconstruction without increased complications.