Back to 2014 Annual Meeting Abstracts

BACKGROUND:
The use of acellular dermal matrix (ADM) in implant based breast reconstruction has been an area of significant debate amongst plastic surgeons. The evolution from aseptic ADM to sterile ADM along with increasing experience has encouraged the development of clear indications for the use of ADM. Here, we explore our institutional experience with acellular dermal matrix to highlight outcomes and indications for use.
METHODS:
After obtaining IRB approval, a retrospective review of all patients undergoing immediate implant based breast reconstruction at a single institution between November 2007 and November 2013 was conducted. Strict guidelines for use were instituted in November 2010 and sterile “ready to use” ADM was introduced in November 2011. Breasts were analyzed into three cohorts: traditional submuscular coverage, aseptic ADM, and sterile ADM. Breasts were then analyzed based on demographics, age, mastectomy specimen weight, type of reconstruction, implant/tissue expander size, type of mastectomy, cancer qualities, and complications.
RESULTS:
During the study period, total of 498 patients underwent 790 breast reconstructions with ADM, 82% (n=648) aseptic and 18% sterile (n=142). The use of ADM in implant based breast reconstruction significantly decreased from 74.7% in 2010 to 19.3% in 2013. However, the use of ADM in direct to implant reconstructions has significantly increased from 18.8% in 2010 to 45.9% in 2013 (p=0.0004). Additionally, the incidence of nipple areolar sparing mastectomy has risen from to 15.4% in 2010 to 40.1% in 2013. Overall major infectious complications associated with implant based breast reconstructions have significantly decreased from 8.7% in 2010 to 2.6% in 2013 (p=0.03) and are similar to total submuscular coverage at 1.4%. Additionally, after the introduction of sterile ADM, major infectious complications in ADM breasts have fallen from at 10.3% (n=56) to 5.6% (n=8) (p=0.112) and explantation has also decreased from 7.7%(n=50) to 2.8%(n=4) (p=0.004).
CONCLUSIONS:
Acellular dermal matrix is a useful adjunct in immediate implant-based breast reconstruction. The development of strict guidelines for use along with the availability of sterile ADM has resulted in dramatically lower infectious complications and explantations.