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Background: Acellular dermal matrices are commonly utilized in implant-based breast reconstruction and continue to evolve. New contour fenestrated Alloderm is sterilely processed, crescent-shaped, and includes prefabricated fenestrations, but has not yet been evaluated in comparison with previous generations of ADM.
Methods: All patients undergoing implant-based breast reconstruction were identified. Patients were stratified by type of implant coverage: aseptic ADM, sterile, ready-to-use ADM, contour fenestrated ADM, or total submuscular coverage. Results were compared with p-values less than 0.05 being deemed significant.
Results: A total of 620 patients (1019 reconstructions) underwent immediate, implant-based breast reconstruction. 8.9%, 16.1%, and 11.7% were performed with aseptic Alloderm, sterile, ready-to-use Alloderm and contour fenestrated Alloderm, respectively (Table 1). Patients with contour fenestrated Alloderm were significantly more likely to have NSM (p=0.0001, 0.0004, 0.0001, respectively) and immediate implant reconstructions (p=0.0001). Those with contour fenestrated Alloderm coverage also had a significantly lesser incidence of infection requiring oral (p=0.0016) and IV antibiotics (p=0.0012) compared to those with aseptic Alloderm coverage. Compared to those with sterile, ready-to-use Alloderm coverage, those with contour fenestrated Alloderm had similar infectious outcomes but significantly more minor mastectomy flap necrosis (p=0.0023). Those with contour fenestrated Alloderm coverage had equivalent infectious outcomes compared to total submuscular coverage but significantly more explantations (p=0.0001) as well as major (p=0.0130) and minor mastectomy flap necrosis (p=0.0001). Diabetes, seroma, mastectomy flap necrosis, aseptic ADM, age of ≥50 years, unilateral reconstruction and TE fill ≥40% were identified as significant independent risk factors for increased infectious complications (Table 2).
Conclusions: Contour fenestrated Alloderm reduces infectious complications compared to aseptic Alloderm and has an equivalent infectious complication profile to sterile, ready-to-use Alloderm and total submuscular coverage.