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Analysis of the National Surgical Quality Improvement Program Database in 19,100 Patients Undergoing Implant-Based Breast Reconstruction: Complication Rates with Acellular Dermal Matrix

Ibrahim, Ahmed M. S. M.D.; Shuster, Marina B.A.; Koolen, Pieter G. L. M.D.; Kim, Kuylhee M.D.; Taghinia, Amir H. M.D.; Sinno, Hani H. M.D., M.Eng.; Lee, Bernard T. M.D., M.B.A.; Lin, Samuel J. M.D.

Plastic and Reconstructive Surgery: November 2013 - Volume 132 - Issue 5 - p 1057–1066
doi: 10.1097/PRS.0b013e3182a3beec
Breast: Outcomes Articles

Background: The use of acellular dermal matrices has become increasingly popular in immediate and delayed tissue expander/implant–based breast reconstruction. However, it is unclear whether their use is associated with increased postoperative complication rates. Using the American College of Surgeons National Surgical Quality Improvement Program database, the authors assessed baseline differences in demographics and comorbidities with and without acellular dermal matrix and determined whether postoperative complication rates varied.

Methods: Using the national surgical database (2005 to 2011), tissue expander/implant–based breast reconstruction cases were extracted using Current Procedural Terminology codes. Differences in preoperative demographics and comorbidities were assessed using chi-square and t test analysis using SPSS. The authors analyzed variations in complication rates and determined whether demographics and comorbidities affected outcomes using multivariate logistical analysis. A post hoc power study was calculated.

Results: Of 19,100 cases, 3301 involved acellular dermal matrix use. Overall complication rates were not statistically significant (acellular dermal matrix, 5.3 percent; non–acellular dermal matrix, 4.9 percent; p = 0.396). Several risk factors were statistically significant associated factors of complications. Higher body mass index was associated with wound complications in both cohorts. In the non–acellular dermal matrix group, body mass index, smoking, and diabetes were associated with major complications, and radiotherapy and steroid use with minor complications.

Conclusions: Acellular dermal matrix use did not appear to increase complication rates in tissue expander/implant–based breast reconstruction in this survey of a national surgical database. There was no significant difference in complication rates between the acellular dermal matrix and non–acellular dermal matrix groups.


Boston, Mass.

From the Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School.

Received for publication March 21, 2013; accepted May 7, 2013.

The first two authors should be considered co–first authors.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. There was no internal or external financial support for this study.

Samuel J. Lin, M.D., 110 Francis Street, Suite 5A, Boston, Mass. 02215,

©2013American Society of Plastic Surgeons