Does Size Matter? Exploring the Impact of Acellular Dermal Matrix Dimensions on Complications in Immediate Breast...

Recent years have seen an increase in prepectoral immediate implant-based reconstructions, requiring larger acellular dermal matrices (ADMs) for implant coverage. Previous studies have suggested a potential rise in infection, flap necrosis, and seroma rates with ADM use in breast reconstructions. However, to our knowledge, no data exist to determine whether these complications are due to the presence of ADM itself or its size. This study aimed to investigate the correlation between ADM size and the incidence of postoperative complications.

A retrospective, single-center analysis was conducted on 229 women (297 breasts) undergoing immediate breast reconstruction with ADM. Reconstructions were stratified into 2 cohorts: small ADM (≤128 cm², n = 91) and large ADM (>128 cm², n = 206). Demographic, comorbidity, surgical, and outcome data were collected and analyzed. Seroma incidence was assessed by time to drain removal.

There was no significant difference in the time to drain removal between cohorts (mean = 13.34 versus 14.09 d). Logistic regression showed a nonsignificant trend toward an increased infection rate in the large ADM cohort (odds ratio = 5.40, P = 0.06). Additionally, no significant association was found between ADM size and a composite score of other major complications (odds ratio = 0.98, P = 0.974).

Seroma and infection were not significantly influenced by ADM size. These findings suggest that the previously observed increase in these postoperative complications is due to the presence of ADM, rather than its size, supporting the continued efficacy and safety of ADM in prepectoral breast reconstructions.