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Analysis of Clinically Significant Seroma Formation in Breast Reconstruction Using Acellular Dermal Grafts

Michelotti, Brett F. MD*; Brooke, Sebastian MD*; Mesa, John MD; Wilson, Matthew Z. MD*; Moyer, Kurtis MD; Mackay, Donald R. MD*; Neves, Rogerio I. MD*; Potochny, John MD*

doi: 10.1097/SAP.0b013e3182923dc9
Clinical Articles

With a rise in tissue expander-based breast reconstructions (TEBRs) using acellular dermal matrix (ADM), we have seen an increase in ADM-specific complications. In this study, we aimed to evaluate clinically significant seroma (CSS) formation—defined by the need for a drainage procedure—to determine if there was a difference in incidence between product types: AlloDerm (AL), DermaMatrix (DM), and FlexHD (FHD). This was a retrospective review of consecutive patients who underwent TEBR at a single institution. The total number of reconstructed breasts was separated into the following 4 groups according to the product type: AL, DM, FHD, or no ADM. We identified the total number of CSSs and compared these data between product types. A logistic regression was performed in an attempt to identify independent risk factors associated with seroma formation. In total, we identified 284 consecutive TEBRs. Overall, there were 17 (7.7%) seromas in 220 breast reconstructions in which ADM was used. When comparing the number of CSS between groups—AL (n = 2, 4.0%), DM (n = 6, 5.4%), FHD (n = 9, 14.75%), and no ADM (n = 1, 1.5%)—we found a significant difference in seroma incidence between product types (P = 0.016). Multivariate analysis identified a strong trend toward FHD as an independent predictor of seroma formation (P = 0.061). Our review suggests that there is strong trend in CSS formation with the use of FHD as compared to other product types and reconstructions in which no ADM was used.

From the *Division of Plastic Surgery, Department of Surgery, Pennsylvania State University, College of Medicine, Milton S. Hershey Medical Center, Hershey, PA; †Plastic Surgery Center Internationale, Montclair, NJ; and ‡Virginia Tech Carilion School of Medicine, Carilion Clinic, Roanoke, VA.

Received March 13, 2013, and accepted for publication, after revision, March 14, 2013.

Presented at the Northeastern Society of Plastic Surgeons Regional Conference at the InterContinental Hotel, Boston, MA, September 2012, where it was awarded “Best Clinical Paper.”

Conflicts of interest and sources of funding: none declared.

Reprints: John Potochny, MD, Division of Plastic Surgery, Department of Surgery, Pennsylvania State University, College of Medicine, Milton S. Hershey Medical Center, 500 University Dr, H071, Hershey, PA 17033. E-mail:

© 2013 by Lippincott Williams & Wilkins