Acellular dermal matrix and prepectoral two-stage breast reconstruction: A cohort analysis of Alloderm, FlexHD and SurgiMend
Jacqueline J. Chu, Shen Yin, Robyn Rubenstein, Cayla McKernan, Tajah Bell, Richard T. Poulton, Carrie S. Stern, Joseph J. Disa, Michelle Coriddi, Joseph H. Dayan, Robert J. Allen Jr., Babak J. Mehrara, Evan Matros, Jonas A. Nelson
Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY
Background: Acellular dermal matrix (ADM) is frequently used in prepectoral breast reconstruction, but few studies have examined its impact on complication risk and even fewer have examined the role of ADM type on complication risk in this patient population, leading to a non-evidence-based approach to ADM selection. The purpose of this study is to determine the risk of complications after immediate, prepectoral, tissue expander (TE) breast reconstruction based on the type of ADM used.
Methods: A retrospective review of post-mastectomy breast reconstruction patients at Memorial Sloan Kettering Cancer Center from 2018-2020 was conducted. All patients had immediate, prepectoral tissue expander reconstruction with use of ADM. Both unilateral and bilateral reconstructions were included. Three types of ADM were compared: 1) Alloderm, 2) FlexHD, and 3) SurgiMend. Complication rates based on the number of tissue expanders were determined for each ADM type. Patient characteristics, including age, race, diabetes, hypertension, and smoking history, cancer treatment characteristics, including chemotherapy and radiotherapy, and surgical characteristics, including mastectomy incision type, axillary lymph node dissection, TE size, and ADM size, were also collected and compared among the three types of ADM. Comparisons were conducted using Fisher’s exact or Kruskal-Wallis tests. Results: Overall, 499 patients (773 TEs) with immediate prepectoral reconstruction with ADM were included in analysis. Of these, 544 (70.3%) TEs used SurgiMend, 143 (18.5%) used Alloderm, and 86 (11.1%) used FlexHD. No patient or cancer treatment characteristics differed among the three cohorts. Surgical characteristics differed in terms of laterality (Unilateral: 67.6% of Alloderm, 36.5% of SurgiMend, 49% of FlexHD, p<0.001), axillary lymph node dissection (29.6% of Alloderm, 18.9% of SurgiMend, 29.8% of FlexHD, p=0.025), and median ADM size [Alloderm: 132cm2 (132-164cm2), SurgiMend: 200cm2 (200-400cm2), FlexHD: 132cm2 (132-215cm2), p<0.001]. Examining complications, no differences were noted for infection, TE malposition, or TE removal (reconstructive failure), but Alloderm had significantly higher rates of seroma formation (Alloderm: 20.3%, SurgiMend: 9.9%, FlexHD: 12.8%, p=0.005). Conclusions: In this large cohort of prepectoral reconstruction patients with similar patient and surgical characteristics among groups, we demonstrate that Alloderm may have an elevated risk of seroma formation compared to SurgiMend and FlexHD. Alloderm was used more commonly earlier in our prepectoral reconstruction experience, so this increased seroma rate may be related to a learning curve with prepectoral drain management. Prospective studies are warranted to evaluate ADM choice for prepectoral reconstruction in a head-to-head fashion.
Back to 2021 Abstracts