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Comparison of Implant-Based Immediate Breast Reconstruction with and without Acellular Dermal Matrix

Vardanian, Andrew J. M.D.; Clayton, John L. M.D., Ph.D.; Roostaeian, Jason M.D.; Shirvanian, Vaheh M.D.; Da Lio, Andrew M.D.; Lipa, Joan E. M.D., M.Sc.; Crisera, Christopher M.D.; Festekjian, Jaco H. M.D.

Plastic and Reconstructive Surgery: November 2011 - Volume 128 - Issue 5 - p 403e–410e
doi: 10.1097/PRS.0b013e31822b6637
Breast: Original Article

Background: Acellular dermal matrix is frequently used in implant-based breast reconstruction to cover the inferior aspect of the breast pocket. Its performance profile remains equivocal. The authors studied whether adding it in implant-based immediate breast reconstruction improved outcomes when compared with non–acellular dermal matrix reconstruction.

Methods: Patients undergoing implant-based immediate breast reconstruction at a single academic medical center were evaluated. Aesthetic outcomes and postoperative complications were assessed and direct comparisons were made between acellular dermal matrix and non–acellular dermal matrix cohorts.

Results: A total of 203 patients underwent 337 immediate expander-based breast reconstructions [with acellular dermal matrix, n = 208 (61.7 percent); without, n = 129 (38.3 percent)]. Patient characteristics, including age at time of reconstruction (mean, 49 ± 11 versus 47 ± 10 years) and body mass index (mean, 23 ± 5 versus 23 ± 3 kg/m2) were similar between groups (p > 0.05). Complications occurred in one-third of patients (33.5 percent). In univariate analyses, acellular dermal matrix use had fewer overall complications (odds ratio, 0.61; 95 percent CI, 0.38 to 0.97). The incidences of seroma/hematoma (p = 0.59), infection (p = 0.31), and wound complications (p = 0.26) did not differ. Aesthetic outcomes were higher in the acellular dermal matrix group. In multivariate logistic regression, acellular dermal matrix use was associated with less capsular contracture (odds ratio, 0.18; 95 percent CI, 0.08 to 0.43) and mechanical shift (odds ratio, 0.23; 95 percent CI, 0.06 to 0.78).

Conclusions: Optimizing the inframammary fold with acellular dermal matrix creates a superior aesthetic result. Its use appears safe and is associated with less capsular contracture and mechanical shift and improvement in the inframammary fold appearance, without increasing postoperative complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Los Angeles, Calif.

From the Division of Plastic and Reconstructive Surgery, University of California, Los Angeles.

Received for publication January 3, 2011; accepted April 15, 2011.

Disclosure: Dr. Crisera is a member of the speaker's bureau for LifeCell Corporation. He did not receive any compensation or financial support for this study. None of the other authors has any commercial associations to disclose or financial conflicts of interest in relation to the content of this article.

Jaco H. Festekjian, M.D.; Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Suite 465, Los Angeles, Calif. 90024, jfestekjian@mednet.ucla.edu

©2011American Society of Plastic Surgeons