I appreciate Dr. Sbitany's comments1 regarding our recent article “Implant-Based Breast Reconstruction Using Acellular Dermal Matrix and the Risk of Postoperative Complications.”2 The comments reiterate the main conclusion of the article that appropriate patient selection, operative technique, and postoperative management are crucial in successful application of acellular dermal matrix to prosthetic breast reconstruction. I agree with Dr. Sbitany that obesity and/or baseline macromastia are generally associated with higher risks, as our study also identified body mass index as an independent risk factor predicting increased complications. In contrast, one can also consider that these patients are the group that may benefit more from use of acellular dermal matrix because of their typical presentation with ptotic pendulous breasts. In contrast to small breasts with minimal ptosis, the effect of lengthening the muscular plane with acellular dermal matrix in larger ptotic mastectomy defects can help to achieve breast reconstructions that mimic the preoperative breast shape and appearance. Careful assessment and excision of any compromised native skin flap, conservative intraoperative tissue expander filling, and drain management should all be crucial elements of the overall treatment protocol. Minimizing dead space within the breast pocket and over the acellular dermal matrix is obviously a basic principle, and the use of soft compression and a surgical bra postoperatively may be helpful.
Although it is indeed unlikely that complications such as seroma and infection can be completely eradicated with any breast reconstruction technique, it is important to recognize potential risk factors associated with specific techniques to develop specific measures to minimize complication rates. This appears to be the fundamental purpose of the implementation by Dr. Sbitany's group of the “checklist.” Although appreciating the clear aesthetic and reconstructive benefits of using acellular dermal matrix as an adjunct to immediate tissue expander or single-stage implant breast reconstructions, it is equally important to critically assess associated complications to minimize morbidity and maximize successful clinical outcomes.
Yoon Sun Chen, M.D.
Plastic and Reconstructive Surgery Division
Brigham and Women's Hospital
75 Francis Street
Boston, Mass. 02115
1.Sbitany H. Techniques to reduce seroma and infection in acellular dermis–assisted prosthetic breast reconstruction. Plast Reconstr Surg
2.Chun YS, Verma K, Rosen H, et al. Implant-based breast reconstruction using acellular dermal matrix and the risk of postoperative complications. Plast Reconstr Surg
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