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Immediate Implant-Based Breast Reconstruction with Acellular Dermal Matrix: A Comparison of Sterile and Aseptic AlloDerm in 2039 Consecutive Cases

Parikh, Rajiv P. M.D., M.P.H.S.; Brown, Gabriella M. B.S.; Sharma, Ketan M.D., M.P.H.; Yan, Yan M.D., M.A., M.H.S., Ph.D.; Myckatyn, Terence M. M.D.

Plastic and Reconstructive Surgery: December 2018 - Volume 142 - Issue 6 - p 1401-1409
doi: 10.1097/PRS.0000000000004968
Breast: Original Articles
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Background: Sterile ready-to-use acellular dermal matrix, introduced as an alternative to aseptic freeze-dried acellular dermal matrix for implant-based breast reconstruction, has been investigated in a limited number of studies. This study compared outcomes in implant-based breast reconstruction with ready-to-use and freeze-dried acellular dermal matrix.

Methods: The authors analyzed patients undergoing implant-based breast reconstruction with either freeze-dried or ready-to-use acellular dermal matrix, including demographics, clinical variables, and outcomes. An a priori power analysis was performed and logistic regression modeling was used to quantify the effect of acellular dermal matrix on outcomes while controlling for potential confounders.

Results: A total of 1285 consecutive patients undergoing 2039 immediate prosthetic breast reconstructions constituted the population: 612 (n = 910 breasts) with freeze-dried matrix and 673 (n = 1129 breasts) with ready-to-use acellular dermal matrix. The freeze-dried matrix cohort had a significantly higher rate of explantation compared with the ready-to-use matrix cohort (18.0 percent versus 12.0 percent; p = 0.0036), but surgical-site infection, wound dehiscence, mastectomy flap necrosis, seroma, and hematoma did not differ significantly between groups. On multivariate regression, patients undergoing reconstruction with freeze-dried matrix, compared to ready-to-use matrix, did not have higher odds of experiencing surgical-site infections (OR, 1.064; p = 0.7455), but did have higher odds of explantation (OR, 1.570; p = 0.0161). Tobacco use (OR, 2.809; p = 0.0002) and body mass index (OR, 1.054; p < 0.0001) were also independent predictors of explantation.

Conclusion: Immediate implant-based breast reconstruction with sterile ready-to-use acellular dermal matrix has a comparable overall safety profile and a lower rate of prosthetic explantations compared with aseptic freeze-dried acellular dermal matrix.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

St. Louis, Mo.

From the Division of Plastic and Reconstructive Surgery and the Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine.

Received for publication January 20, 2018; accepted May 9, 2018.

Disclosure:Dr. Myckatyn receives investigator-initiated grant funding and consultant and advisory board fees from Allergan, consultant fees from LifeCell, investigator-initiated grant funding and consultant fees from RTI, and advisory board fees from Viveve. None of the authors has any financial disclosures in relation to the content of this article.

Terence M. Myckatyn, M.D., Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, 1020 North Mason Road, Suite 110, Building 3, St. Louis, Mo. 63141, myckatyn@wustl.edu

Copyright © 2018 by the American Society of Plastic Surgeons