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Comparative Complications and Costs of Tissue Expander-Based Breast Reconstruction with Alloderm versus Surgimend
Olivia Julian
*, Christopher Fullmer, Xingchen Li, Dino Ravnic
Penn State University, Hershey, PA
Background: Acellular dermal matrices (ADM) allow for staged breast reconstruction in the prepectoral or submuscular plane. Alloderm is the most widely used due to perceived benefits of human sourcing. However, there are also xenogenic ADM, but direct evaluation between the two classes is incomplete. This study compares both non-surgical and surgical complication rates along with cost when either Alloderm (human) or Surgimend (bovine) is used for tissue expander-based breast reconstruction.
Methods: A retrospective chart review was conducted on all patients undergoing staged tissue expander (TE) breast reconstruction with Alloderm or Surgimend over 5-years at a single institution. Primary outcomes were operative and nonoperative complications - specifically seroma formation, cellulitis, and implant infection. Secondary outcomes included the total time and cost per patient to reach final reconstruction.
Results: 120 breasts (65 patients) were identified. 55 breasts (45.8%) received Alloderm, and 65 (54.2%) received Surgimend. There were significantly higher rates of complications requiring surgery in the Alloderm group (20.0% vs. 6.2%, p=0.028). Patients receiving Surgimend had a shorter mean expansion phase than those receiving Alloderm (7 vs. 9 months; p=0.015). Mean total reconstructive cost per patient was $42,613 higher with Alloderm reconstruction ($347,061 vs. $304,448; p=0.031).
Conclusion: Patients with Alloderm experienced significantly more operative complications than Surgimend, as well as a longer and more costly timeline to final reconstruction. Despite its xenogenicity, Surgimend seems to provide safer coverage of tissue expanders, at less expense, and with faster time to final reconstruction.
Complications and Cost of Alloderm versus Surgimend Breast Reconstruction
| | Alloderm (n=55 breasts) | Surgimend (n=65 breasts) | Total (n=120 breasts) | P-value |
| Complications Not Requiring Surgery | 9 (16.4%) | 10 (15.4%) | 19 (15.8%) | 1.000 |
| Complications Requiring Surgery | 11 (20.0%) | 4 (6.2%) | 15 (12.5%) | 0.028* |
| Average Time to Final Reconstruction (months) | 9 | 7 | 8 | 0.015* |
| Average Cost per Patient (USD) | $347,061.81 | $304,448.37 | - | 0.031* |
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