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Acellular Dermis–Assisted Prosthetic Breast Reconstruction versus Complete Submuscular Coverage: A Head-to-Head Comparison of Outcomes

Sbitany, Hani, M.D.; Sandeen, Sven N., M.D.; Amalfi, Ashley N., M.D.; Davenport, Mark S., M.D.; Langstein, Howard N., M.D.

Plastic and Reconstructive Surgery: December 2009 - Volume 124 - Issue 6 - p 1735-1740
doi: 10.1097/PRS.0b013e3181bf803d

Background: Complete submuscular tissue expander coverage affords the best protection against implant exposure but restricts lower pole expansion. Techniques using acellular dermis as a pectoralis muscle extension can allow for more rapid fill of the expander and better control of the inframammary fold. This study compares both techniques with regard to relevant outcomes.

Methods: Results of 100 consecutive breast expander reconstructions performed by two surgeons between 2004 and 2007 were retrospectively reviewed. Patient demographics, expander coverage type, adjuvant treatment, length and characteristics of the expansion, and incidence and types of complications were analyzed.

Results: One hundred women underwent breast reconstruction with 172 expanders, in 50 using complete submuscular placement and in 50 using partial subpectoral placement with acellular dermis. The patient groups were similar in terms of demographic data. Mean number of fills to complete reconstruction was 4.31 in the submuscular group and 1.72 in the acellular dermis group (p = 0.0001). Mean intraoperative fill volume was 130 cc in the submuscular group, compared with 412 cc per expander in the acellular dermis group (p = 0.0001). Fisher's exact test demonstrated no significant difference in total complication rate between the two groups (14 percent versus 18 percent; p = 0.79).

Conclusions: Acellular dermis allowed for a greater initial fill of saline. This potentially improves cosmetic outcome, as it better capitalizes on preserved mastectomy skin for reconstruction. The authors conclude that acellular dermis–assisted implant breast reconstruction has a safety profile no worse than that of complete submuscular coverage but offers the benefit of fewer expansions and the potential for more predictable secondary revisions.

Rochester, N.Y.

From the Division of Plastic and Reconstructive Surgery, University of Rochester.

Received for publication December 26, 2008; accepted June 29, 2009.

Presented at the 25th Annual Meeting of the Northeastern Society of Plastic Surgeons, in Philadelphia, Pennsylvania, October 2 through 5, 2008.

Disclosure:Howard N. Langstein, M.D., is a member of the speaker's bureau for LifeCell Corporation. He did not receive any compensation or financial support for this study. The remaining authors have no commercial associations to disclose. None of the authors has a financial interest in any of the products or devices mentioned in this article.

Howard N. Langstein, M.D. 601 Elmwood Avenue, Box 661; Rochester, N.Y. 14642;

©2009American Society of Plastic Surgeons