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Association between ADM thickness and Complication Risks in Tissue Expander Breast Reconstruction
Basil Nwaoz, MD1, Andrew M. Nouri, MD1, Kanad Ghosh, BA2, Jocellie Marquez, MD, MBA1, Angela Mironis BS2, Tara L. Huston, MD, FACS1, Jason Ganz, MD1, Duc Bui, MD1, Sami Khan, MD, FACS1
1Stony Brook University Hospital, Stony Brook, NY, 2Stony Brook University School of Medicine, Stony Brook, NY

Background: Tissue-expander breast reconstruction (TEBR) is the most common method of reconstruction following mastectomy. The use of acellular dermal matrix (ADMs) during this procedure offers many advantages but has also been associated with increased complications. One important factor to consider in reducing complications is ADM selection. Though work has been done in comparing complications between ADM brands, there is a paucity of data regarding the importance of ADM thickness. In this study, we examine the association of ADM thickness with complications in TEBR.
Methods: A retrospective review was conducted on patients undergoing immediate TEBR with ADM from 2010 2019. Patients were divided based on ADM thickness: 0.53mm 1.2mm (Group 1) versus >1.2mm (Group 2). Patients undergoing delayed or autologous reconstruction, or TEBR without ADM, were excluded. Only complications occurring between Stage 1 and Stage 2 of reconstruction were examined.
Results: 228 reconstructions (137 patients) were included in the study; Group 1 included 134 reconstructions (80 patients), Group 2 included 94 reconstructions (57 patients). Group 2 had a significantly higher rate of diabetes mellitus II than Group 1 (0% vs 7.1%, p=.016). Logistic regression did not reveal diabetes mellitus II to increase the likelihood of any of the complications studied. There was otherwise no significant difference in age, body mass index (BMI), tobacco use, hypertension, or radiation exposure prior to or following reconstruction between the two groups. Comparison of complications between individually reconstructed breasts in Group 1 versus Group 2 revealed significantly increased rates of skin necrosis (3.0% versus 10.6%, p=.018) among Group 2 breasts. Rates of infection were also increased among Group 2 (10.4% vs 18.1%, p=.098) which approached significance. There was no difference in reconstructive failure, conversion to autologous reconstruction, seroma, wound dehiscence, hematoma, or fat necrosis between the two groups.
Conclusion: This study represents the largest analysis of the effect of ADM thickness on complications after TEBR. Thicker ADMs were significantly correlated with increased rates of skin necrosis, though there may not likely be a direct causality in this relationship. The increased infection rate, though not significant, may be caused by the potential for the ADM to act as a nidus for infection and a prolonged time of thicker ADM incorporation. Our results show that ADM thickness does indeed play a role in complication rates, and selection of ADM should be conducted carefully.


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