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Utility of Acellular Dermis–Assisted Breast Reconstruction in the Setting of Radiation: A Comparative Analysis

Seth, Akhil K. M.D.; Hirsch, Elliot M. M.D.; Fine, Neil A. M.D.; Kim, John Y. S. M.D.

Plastic and Reconstructive Surgery: October 2012 - Volume 130 - Issue 4 - p 750–758
doi: 10.1097/PRS.0b013e318262f009
Breast: Original Articles
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Discussion

Background: The role of acellular dermis in immediate prosthetic breast reconstruction remains unclear, particularly within a radiated field. The authors evaluated and compare outcomes following reconstruction with and without acellular dermis, and analyzed patients exposed to radiation therapy.

Methods: Retrospective review of 417 consecutive patients (592 breasts) treated from January of 2006 to October of 2008 at one institution was performed. Relevant patient characteristics and follow-up were recorded. Complications were categorized by type and end outcome, including nonoperative, operative, or explantation. Both groups had comparable follow-up (acellular dermis, 23.2 ± 8.9 months; no acellular dermis, 24.4 ± 12.7 months; p = 0.23). Appropriate statistical analyses, including multiple regression, were performed.

Results: Acellular dermis patients (n = 199 breasts) had larger body mass indexes (p = 0.0001) and more nipple-sparing mastectomies (p = 0.04) than non–acellular dermis patients (n = 393 breasts). Breasts with acellular dermis had larger intraoperative fill volumes (p < 0.0001) and decreased postoperative expansions (p = 0.02), but no decrease in time to implant exchange. There were no significant differences in complication profiles between acellular dermis and non–acellular dermis breasts, after adjusting for other relevant patient variables on regression analysis. After stratifying patients by exposure to radiation, acellular dermis breasts had a decreased risk of all complications related to radiation as compared with non–acellular dermis breasts.

Conclusions: This study suggests that acellular dermis does not adversely affect complication rates following prosthetic breast reconstruction. It may be advantageous, however, in select patients, particularly those undergoing postoperative radiation therapy. Therefore, the choice to use acellular dermis does not compromise outcomes but should be individualized to each patient.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Chicago, Ill.

From the Division of Plastic Surgery, Feinberg School of Medicine, Northwestern University.

Received for publication April 27, 2012; accepted April 30, 2012.

Presented at the American College of Surgeons Clinical Congress, Surgical Forum, in San Francisco, California, October 26, 2011.

Disclosure:Dr. Kim receives research funding from Mentor (Santa Barabara, Calif.) and the Musculoskeletal Transplant Foundation (Edison, N.J.). Dr. Fine receives research funding from Allergan (Irvine, Calif.). The remaining authors have no financial interests to disclose.

John Y. S. Kim, M.D., Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, 675 North Saint Clair, Suite 19-250, Chicago, Ill. 60611

©2012American Society of Plastic Surgeons