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Trends in Acellular Dermal Matrix Utilization in Postmastectomy Tissue Expander Placement: An Eleven-Year Single Institution Review of 1,237 Patients
Stuart D. Powell
*, Dylan K. Kim, Meghan Perez, David Dugue, Jeffrey A. Ascherman, Christine H. Rohde
Division of Plastic and Reconstructive Surgery, Columbia University Irving Medical Center, New York, NY
Introduction: The acellular dermal matrix (ADM) confers demonstrated benefits in device-based breast reconstruction by providing an additional layer for vascularization. The acceptance of ADM in alloplastic reconstruction has created fluctuations in reconstruction patterns over the last decade . This study investigates patterns and clinical outcomes of tissue expander placement with the advent of ADM.
Methods: Patients who underwent placement of tissue expanders for breast reconstruction were identified in a retrospective chart review within a single academic tertiary referral hospital from January 2013 to August 2023. Demographic, oncologic, and clinical characteristics were collected for each patient. Associations between variables with type of plane placement were evaluated with corrected pairwise comparisons (
p<0.05).
Results: The final cohort included tissue expander placement for 2,071 breasts among 1,237 patients of five plastic surgeons. The most common plane of placement was total submuscular (74.0%), followed by dual plane (14.0%), prepectoral with ADM (10.5%), and prepectoral alone (1.6%). The prevalence of dual plane placement decreased from 24.4% in 2013-2014 to 2.3% in 2021-2023, whereas prepectoral placement with ADM increased from 0.0% to 22.1%. Patients receiving dual plane placement and prepectoral placement with ADM were similar with respect to BMI and final tissue expander volume, which were both lower when compared to submuscular placement (
p<0.05), and also were not significantly different in rates of hypertension, smoking history, neoadjuvant chemotherapy, or prophylactic indication (
p>0.05). Dual plane placement and prepectoral placement with ADM shared significantly higher rates of infection (11.1% and 8.2%) than submuscular placement (3.2%) (
p<0.05).
Conclusion: The choice of plane for tissue expander placement has evolved significantly over the last decade in our institution. Prepectoral placement with ADM has largely replaced dual plane placement with a non-inferior outcome profile and similar comorbidity burden.
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