Acellular human dermis implantation in 153 immediate two-stage tissue expander breast reconstructions: determining the incidence and significant predictors of complications.
BACKGROUND
Little information exists on the incidence of complications after acellular human dermis implantation in two-stage tissue expander breast reconstruction. The purpose of this study was to evaluate the incidence of postoperative adverse events and identify significant predictors of complications in acellular human dermis tissue expander breast reconstruction.


METHODS
This study accrued all patients from January of 2004 through April of 2008 undergoing two-stage immediate tissue expander breast reconstruction using acellular human dermis. A total of 153 expanders were placed. Complications were assessed. Univariate and multivariate logistic regression modeling was performed. Comparison of complication rates using the traditional (non-acellular human dermis) technique from concurrent (2004 to 2008) and consecutive time periods (2001 to 2003) for 2910 and 1170 expanders, respectively, is provided.


RESULTS
A total of 153 expanders were implanted in 96 women: 39 unilateral and 57 bilateral. Eleven (7.2 percent) were removed due to infection (n = 5, 3.3 percent), exposure (n = 4, 2.6 percent), or patient preference (n = 2, 1.3 percent). Other complications included cellulitis (3.9 percent), seroma (7.2 percent), hematoma (2.0 percent), mastectomy flap necrosis (4.6 percent), and leak/failed expansion (0.0 percent); 92.8 percent were successfully expanded and exchanged for a permanent implant. Eleven seromas (7.2 percent) were identified; nine underwent aspiration. None of these resulted in infection or reconstructive failure. Univariate analysis revealed age, body mass index, axillary dissection, and postoperative chemotherapy to be associated with reconstructive failure (p < 0.05). Multivariate analysis revealed that age, body mass index, and axillary dissection are independent risk factors for developing complications (p < 0.05).


CONCLUSIONS
Acellular human dermis is a useful adjunct for intraoperative pocket development in immediate tissue expander reconstruction but can result in an increased risk of complications, in particular, seroma and reconstructive failure.
Antony
Anuja K
AK
New York, N.Y.; Boston, Mass.; and Chicago, Ill. From the Plastic and Reconstructive Surgery Service, Memorial Sloan-Kettering Cancer Center; Harvard School of Public Health; and University of Illinois at Chicago.
McCarthy
Colleen M
CM
Cordeiro
Peter G
PG
Mehrara
Babak J
BJ
Pusic
Andrea L
AL
Teo
Esther H
EH
Arriaga
Alexander F
AF
Disa
Joseph J
JJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001672:Biocompatible Materials / Q000627:therapeutic use*; D002481:Cellulitis / Q000453:epidemiology / Q000473:pathology; D020405:Dermis / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D016462:Mammaplasty / Q000379:methods* / Q000706:statistics & numerical data*; D008408:Mastectomy / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D009336:Necrosis; D011183:Postoperative Complications / Q000453:epidemiology* / Q000473:pathology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D049291:Seroma / Q000453:epidemiology / Q000473:pathology; D013530:Surgical Wound Infection / Q000453:epidemiology; D055815:Young Adult
D001672:Biocompatible Materials