Biosynthetic Mesh as an Alternative to ADM in Tissue Expander-Based Breast Reconstruction
Adam S. Levy, MD, Jaime L. Bernstein, MD, David M. Otterburn, MD.
New York-Presbyterian Hospital, New York, NY, USA.
BACKGROUND: Acellular dermal matrix (ADM) is commonly utilized during immediate expander-based breast reconstruction, with potential advantages of greater intraoperative expansion, decreased time to complete expansion, and decreased rates of capsular contracture. However, ADM is associated with increased infection rate, seroma, and subsequent reconstructive failure. Poly-4-hydroxybutyric acid (P4HB) mesh is a large pore, biosynthetic scaffold shown to fully resorb and incorporate host tissues within 18 months in pre-clinical data. We sought to compare outcomes between the use of P4HB and ADM in immediate expander-based reconstruction.
METHODS: Here we review 112 cases (62 patients) of breast reconstruction by a single surgeon (DMO) using P4HB mesh from October 2014 to June 2016 compared to 192 cases (107 patients) of ADM between November 2011 and October 2014. In all patients, reconstruction was performed immediately following mastectomy for confirmed or high genetic risk cases of breast cancer. Data was analyzed by Fisher’s exact test or unpaired T-tests. IRB approval was obtained for purposes of this study.
RESULTS: Baseline characteristics were similar between P4HB and ADM groups. Overall infection rates were lower, but not significantly with P4HB (11% vs 17%, p=0.18). Time to drain removal was significantly lower with P4HB (15 vs 18d, p=0.008), although there was no difference in rates of seroma (0.9% vs 3%, p=0.43). Similar numbers of patients underwent external beam radiation (XRT; 22% vs 24%) and received chemotherapy in each group (48% vs 45%). By univariate analysis, all odds ratios (OR) were decreased with use of P4HB, including risk of major complications (0.55), seroma (0.17), infection (0.59), need for re-operation (0.78) and skin necrosis (0.77). In non-radiated patients, patients with P4HB also had a trend toward lower rates of infection (17 vs 11%; p=0.25).
CONCLUSIONS: These data show biosynthetic P4HB mesh to be a safe alternative to ADM in expander-based breast reconstruction, with trends toward decreased rates of infection and seroma formation. There was also a trend toward decreased infection rates in P4HB patients that were not radiated. Although our results are limited to a small series of initial patients and underpowered, P4HB porous mesh may be a promising novel technique to decrease complications inherent to use of ADM.
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