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Total Muscle Coverage versus AlloDerm Human Dermal Matrix for Implant-Based Breast Reconstruction

Ivey, J. Simon, M.D.; Abdollahi, Hamid, M.D.; Herrera, Fernando A., M.D.; Chang, Eric I., M.D.

Plastic and Reconstructive Surgery: January 2019 - Volume 143 - Issue 1 - p 1-6
doi: 10.1097/PRS.0000000000005076
Breast: Original Articles
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Background: Prosthetic breast reconstruction is the most common method for treatment of patients undergoing mastectomy. Acellular dermal matrix has become more popular in implant-based breast reconstruction.

Methods: The authors conducted a retrospective review of all patients undergoing prosthetic breast reconstruction between August of 2002 and December of 2013. Patients were analyzed in terms of demographics, fill volumes, number of expansions, costs, and complications.

Results: A total of 284 patients underwent mastectomy surgery with 481 implant-based breast reconstructions. Four hundred eight tissue expanders had total muscle coverage, whereas 73 had AlloDerm. The rate of overall complications and major complications was significantly higher in the AlloDerm group: 20.5 percent versus 8.8 percent (p = 0.005), and 13.7 percent versus 5.1 percent (p = 0.0001), respectively. The mean initial fill volume was significantly lower in the total muscle coverage group compared to the acellular dermal matrix group (54 ± 47 versus 167 ± 139; p = 0.00003), resulting in a higher number of expansions (8.1 versus 5.8; p = 0.000051) and longer time to full expansion (60.2 days versus 43.3 days; p = 0.0002). This did not translate into a faster time to expander exchange (162.4 days versus 162.3 days; p = 0.13). Use of AlloDerm added a mean cost of $2217 for each breast.

Conclusions: Implant-based breast reconstruction has evolved with the advent of acellular dermal matrices. Although the use of acellular dermal matrix allows increased initial fill volumes and fewer total expansions, there is an increased risk of complications and increased costs, especially in patients undergoing bilateral reconstruction. Total muscle coverage remains an excellent option for providing quality breast reconstruction without increased complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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Charleston, S.C.; and Shrewsbury, N.J.

From the Division of Plastic and Reconstructive Surgery, Medical University of South Carolina; and The Institute for Advanced Reconstruction, The Plastic Surgery Center.

Received for publication March 5, 2018; accepted June 5, 2018.

Presented at the 96th Annual Meeting of the American Association of Plastic Surgeons, in Austin, Texas, May 25 through 28, 2017.

Disclosure:None of the authors has a financial interest in any of the products or devices mentioned in this article.

Eric I. Chang, M.D., The Institute for Advanced Reconstruction, The Plastic Surgery Center, 535 Sycamore Avenue, Shrewsbury, N.J. 07702, echangmd@tpscnj.com

Copyright © 2018 by the American Society of Plastic Surgeons