Acellular Dermal Matrix-Assisted, Prosthesis-Based Breast Reconstruction: A Comparison of SurgiMend, AlloDerm, and DermACELL
Lauren E. Berger*, Daisy L. Spoer, Alice C. Bell, Samuel S. Huffman, Varsha Harish, Brian N. Truong, Zoe K. Haffner, David H. Song, Kenneth L. Fan
Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington,
Acellular dermal matrices (ADMs) are frequently employed in immediate prosthesis-based breast reconstruction (iPBR) to provide structural support and optimize outcomes. Despite differences in ADM derivatives, few studies directly compare their outcomes in the setting of iPBR. We thus sought to conduct a large head-to-head study comparing three ADMs used across our institution.
A multicenter retrospective review of patients undergoing iPBR with SurgiMend (fetal bovine-derived; Integra LifeSciences, Princeton, NJ), AlloDerm (human-derived; LifeCell Corp., Bridgewater, NJ), or DermACELL (human-derived; Stryker Corp., Kalamazoo, MI) between January 2014 to July 2022 was performed. Primary outcomes included rates of unplanned explantation and total reconstructive failure. Secondary outcomes included 90-day postoperative complications and long-term rates of capsular contracture development.
A total of 738 patients equating to 1,228 operated breasts underwent iPBR during the study period. Of these, 405 patients received DermACELL (54.9%), 231 received AlloDerm (31.3%), and 102 received SurgiMend (13.8%). Rates of short-term complications, total reconstruction failure, reoperation within 90 days, capsular contracture, and unplanned explantation were comparable. These findings remained true upon multivariate analysis accounting for baseline differences between cohorts, whereby ADM type was not an independent predictor of any outcome of interest. Conversely, factors such as body mass index, diabetes mellitus, smoking history, neoadjuvant and adjuvant chemotherapy, adjuvant radiation, skin-sparing mastectomy, Wise pattern and periareolar incisions, use of tissue expanders, and a subpectoral plane of insertion were significant predictors of postoperative complications (Table 1).
Low rates of complications across all cohorts support the equivalency of fetal bovine and human-derived ADMs in iPBR. Patient characteristics and operative approach are likely more predictive of postoperative outcomes than the ADM derivative alone.
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