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Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction

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Postoperative complications in prosthesis-based breast reconstruction using acellular dermal matrix.

Allen S Liu¹, Huang-Kai Kao, Richard G Reish

¹Boston, Mass.; and Linkou, Taiwan From the Division of Plastic Surgery, Brigham and Women's Hospital; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital; and Division of Plastic Surgery, Massachusetts General Hospital.

Plastic and Reconstructive Surgery

|January 14, 2011

Summary

Acellular dermal matrix (ADM) use in immediate breast reconstruction increased overall surgical complications, particularly wound infections. Patient selection is crucial, especially for smokers and those with high BMI, to mitigate risks associated with ADM.

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Published on: January 7, 2019

Area of Science:

Plastic Surgery
Reconstructive Surgery
Biomaterials in Medicine

Background:

Acellular dermal matrix (ADM) is frequently used in prosthesis-based breast reconstruction.
The study investigates the association between ADM use and complication rates in immediate breast reconstruction.

Purpose of the Study:

To determine if acellular dermal matrix (ADM) use in immediate prosthesis-based breast reconstruction is linked to a higher incidence of complications.
To identify risk factors for surgical complications in this patient population.

Main Methods:

A retrospective review of 470 immediate prosthesis-based breast reconstructions over 5.5 years.
Patients were divided into two groups: those who received acellular dermal matrix (ADM) and those who did not.
Data collected included patient comorbidities, radiation status, prosthesis details, and complication types.

Main Results:

The acellular dermal matrix (ADM) group showed a statistically significant increase in overall surgical complication rates (19.5% vs. 12.3%, p < 0.001).
While major infection risk was elevated in the ADM group (4.9% vs. 2.5%), it did not reach statistical significance (p = 0.172).
Overall wound infection rate was significantly higher in the ADM group (6.8% vs. 2.5%, p = 0.031), though multivariate analysis did not confirm ADM as an independent risk factor.

Conclusions:

Judicious patient selection is recommended for acellular dermal matrix (ADM) use, particularly for smokers and individuals with elevated BMI.
While ADM facilitates higher initial volumes and fewer expansions, caution is advised regarding excessive initial fill volumes to minimize complications.