title: The use of acellular dermal matrix in immediate two-stage tissue expander breast reconstruction.
abstract: BACKGROUND
  Acellular dermal matrix is commonly used in implant-based breast reconstruction to allow for quicker tissue expansion with better coverage and definition of the lower pole of the breast. This study was performed to analyze complications associated with its use in immediate two-stage, implant-based breast reconstruction and to subsequently develop guidelines for its use.
  
  
  METHODS
  A retrospective analysis of 628 consecutive immediate two-stage tissue expander breast reconstructions at a single institution over a 3-year period was conducted. The reconstructions were divided into two groups: reconstruction with acellular dermal matrix and reconstruction without it. Demographic information, patient characteristics, surface area of acellular dermal matrix, and complications were analyzed and compared.
  
  
  RESULTS
  A total of 407 patients underwent 628 immediate two-stage, implant-based breast reconstructions; 442 reconstructions (70.3 percent) used acellular dermal matrix and 186 (29.6 percent) did not. The groups had similar patient characteristics; however, major complications were significantly increased in the acellular dermal matrix group (15.3 versus 5.4 percent; p = 0.001). These complications included infection requiring intravenous antibiotics (8.6 versus 2.7 percent; p = 0.001), flap necrosis requiring excision (6.7 versus 2.7 percent; p = 0.015), and explantation of the tissue expander (7.7 versus 2.7 percent; p = 0.004).
  
  
  CONCLUSIONS
  Use of acellular dermal matrix in immediate two-stage, implant-based breast cancer reconstruction is associated with a significant increase in major complications. Therefore, it should only be used in specific patients and in minimal amounts. Indications for its use include single-stage permanent implant reconstruction and inadequate local muscle coverage of the tissue expander.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: New York, N.Y. From New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery.
authors.forename: Katie E
authors.initials: KE
authors.lastname: Weichman
authors.forename: Stelios C
authors.initials: SC
authors.lastname: Wilson
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Weinstein
authors.forename: Alexes
authors.initials: A
authors.lastname: Hazen
authors.forename: Jamie P
authors.initials: JP
authors.lastname: Levine
authors.forename: Mihye
authors.initials: M
authors.lastname: Choi
authors.forename: Nolan S
authors.initials: NS
authors.lastname: Karp
mesh_terms: D000328:Adult; D019928:Breast Implantation / Q000009:adverse effects*; D018427:Breast Implants / Q000009:adverse effects; D001943:Breast Neoplasms / Q000517:prevention & control / Q000601:surgery*; D003094:Collagen / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D008408:Mastectomy; D008875:Middle Aged; D012189:Retrospective Studies; D015626:Tissue Expansion / Q000009:adverse effects*; D015625:Tissue Expansion Devices / Q000009:adverse effects
chemical_list: C440568:Alloderm; D003094:Collagen