NESPS - Early Reduction in Capsular Contracture With Acellular Dermal Matrix Does Not Persist Long Term After Implant-Based Breast Reconstruction

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Early Reduction in Capsular Contracture With Acellular Dermal Matrix Does Not Persist Long Term After Implant-Based Breast Reconstruction
Albert Rancu¹, Andrew Salib¹, Martin Kauke-Navarro¹, Victoria Kong¹, Jonathan N. Grauer¹, Michael Alperovich¹
¹. Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven , CT, United States.

Background:
The role of acellular dermal matrix (ADM) in reducing capsular contracture following implant-based breast reconstruction remains controversial. Prior studies have reported conflicting findings, and the magnitude of any protective effect remains uncertain.

Methods:
Using the PearlDiver database, we identified patients undergoing implant-based breast reconstruction with 5-year longitudinal follow-up. To reduce confounding, patients with any postoperative infection, wound complication, or prior history of radiotherapy were excluded. Patients undergoing reconstruction with ADM were propensity matched to those without ADM on age, Charlson Comorbidity Index, obesity, smoking status, diabetes, and immediate versus delayed reconstruction. Capsular contracture was identified using ICD diagnosis codes.

Results:
Matched cohorts included 6,546 patients undergoing reconstruction with ADM and 12,710 without ADM. ADM use was associated with a statistically significant reduction in capsular contracture within the first 2 years post surgery. Contracture rates at 12 months were 4.9% versus 6.2% and at 24 months of 6.9% versus 8.0% for ADM vs Non-ADM cohorts (both p<0.01). However, this difference diminished over time, with 5-year cumulative contracture rates of 10.3% in the ADM cohort and 10.6% in the non-ADM cohort (p = 0.52). Kaplan-Meier analysis demonstrated no significant long-term difference in contracture-free survival between cohorts after 5 years (log-rank p=0.49).

Conclusions:
ADM use is associated with a small reduction in early capsular contracture rates after implant-based breast reconstruction, but the magnitude of benefit is modest and does not persist long term.

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