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Acellular Dermal Matrix–Assisted Direct-to-Implant Breast Reconstruction and Capsular Contracture: A 13-Year Experience

Salzberg, C. Andrew M.D.; Ashikari, Andrew Y. M.D.; Berry, Colleen A.R.N.P., F.N.P.-B.C.; Hunsicker, Lisa M. M.D.

Plastic and Reconstructive Surgery: August 2016 - Volume 138 - Issue 2 - p 329-337
doi: 10.1097/PRS.0000000000002331
Breast: Original Articles
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Discussion
Coding Perspective

Background: Use of acellular dermal matrix for implant-based breast reconstruction appears to be associated with a lower incidence of capsular contracture compared with standard reconstruction. The majority of acellular dermal matrix studies were, however, of short duration; thus, long-term incidence of capsular contracture with acellular dermal matrix use is unknown.

Methods: Patients undergoing acellular dermal matrix–assisted breast reconstruction from December of 2001 to May of 2014 at two institutions were evaluated. Cumulative incidence of capsular contracture was determined by the performing surgeon. A retrospective chart review was performed on prospectively gathered data on patient-, breast-, surgery-, and implant-related characteristics that were analyzed as potential risk factors for the development of capsular contracture.

Results: A total of 1584 breast reconstructions in 863 patients were performed. Mean follow-up of patients was 4.7 years; 45 percent of patients had greater than or equal to 5 years of follow-up. The cumulative incidence of capsular contracture was 0.8 percent. Smaller implant size (<400 ml) and postoperative radiotherapy were significantly associated with an increased risk of capsular contracture, but the incidence of capsular contracture was 1.9 percent in irradiated breasts. All capsular contractures developed within the first 2 years, with no new events with longer follow-up.

Conclusions: In this long-term study, the cumulative incidence of capsular contracture with acellular dermal matrix–assisted reconstruction remains low, even in irradiated breasts. Capsular contracture appears to be an early event, and longer follow-up does not appear to increase the incidence, suggesting that acellular dermal matrix may truly mitigate the development of capsular contracture as opposed to delaying its occurrence.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Coding Perspective for this Article is on Page 335.

New York, N.Y.; and Littleton, Colo.

From the Icahn School of Medicine, Mount Sinai Health Systems; the Ashikari Breast Center; and Revalla Plastic Surgery & Medical Aesthetics.

Received for publication December 16, 2015; accepted March 14, 2016.

Presented in part at Plastic Surgery The Meeting 2014, Annual Meeting of the American Society of Plastic Surgeons, in Chicago, Illinois, October 10 through 14, 2014; and the 53rd Annual Scientific Meeting of the Northwest Society of Plastic Surgeons, in Kailua-Kona, Hawaii, February 14 through 18, 2015.

Disclosure:Dr. Hunsicker and Dr. Ashikari are consultants to LifeCell Corporation. Ms. Berry and Dr. Salzberg have no relevant disclosures. No funds were received or utilized for the research presented in this article.

C. Andrew Salzberg, M.D., Icahn School of Medicine, Mount Sinai Health Systems, New York, N.Y., asalzbergmd@yahoo.com

Copyright © 2016 by the American Society of Plastic Surgeons