Comparing Complication Rates Between Use and Nonuse of Acellular Dermal Matrix in Breast Reconstructions With Prepectoral Tissue Expanders
Ethan L. Plotsker, BA1; Francis D. Graziano, MD1; Robyn N. Rubenstein, MD1; Kathryn Haglich, BS, MS1; Robert J. Allen Jr, MD1; Michelle R. Coriddi, MD1; Joseph H. Dayan, MD1; Evan Matros, MD, MPH, MMSc1; Babak J. Mehrara, MD1; Joseph J. Disa, MD1; Jonas A. Nelson, MD, MPH1
1Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Background: Prepectoral tissue expander (TE) placement for two-stage postmastectomy reconstruction has become a widely accepted technique with the potential to reduce animation deformity and postoperative pain. Reconstructive success requires adequate soft tissue coverage, and acellular dermal matrix (ADM) may play an important role as an adjunct. The aim of this study was to examine whether early outcomes and complications differ according to ADM use.
Methods: We performed a retrospective cohort study of all patients at our institution who underwent prepectoral breast reconstruction from January 2018 to June 2021. Variables of interest included patient demographics and comorbidities. The primary outcome was TE loss; secondary outcomes included other complications (e.g., TE exposure, infection, skin flap necrosis requiring revision, and seroma) at 90 days.
Results: Data on 714 patients with 1,225 TEs (1,060 with ADM, 165 without) were analyzed. Baseline demographics did not differ by ADM use, though mastectomy breast tissue weight was higher in patients without ADM (750.3 g vs. 540.8 g, p < 0.001). Rates of TE loss were similar in reconstructions without (6.7 percent) and with (3.8 percent) ADM (p = 0.09). Secondary outcomes of interest did not differ significantly between cohorts.
Conclusions: Among patients undergoing breast reconstruction with prepectoral TEs, complication profiles, including rates of expander loss and infection, did not differ by ADM use. This suggests that in properly selected patients, prepectoral TE breast reconstruction can be performed safely without ADM. Future research should examine long-term capsular contracture and implant position in patients with and without ADM placement.
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