title: Complications in tissue expander breast reconstruction: a comparison of AlloDerm, DermaMatrix, and FlexHD acellular inferior pole dermal slings.
abstract: Acellular dermal matrix (ADM) is frequently used in tissue expander breast reconstruction (TEBR) for coverage of the inferior pole. Several published studies have suggested increased rates of complications with the use of ADM. It is unknown, however, if the type of ADM used for TEBR impacts complication rates. The aim of this study is to compare 3 different types of ADM for TEBR in regard to clinically significant complications, specifically infection. We performed a retrospective analysis of primary breast cancer-related TEBR with or without ADM. Exclusion criteria consisted of prior major breast surgery, inadequate data, or loss to follow-up. Reconstructions were grouped by dermal sling type, AlloDerm, DermaMatrix (DM), FlexHD (FHD), or no ADM. Complications included cellulitis, abscess, seroma, expander leak or puncture, skin necrosis, wound dehiscence, or hematoma. Those requiring admission to hospital or reoperation were considered significant. Of 284 breasts reconstructed, 49 used AlloDerm, 110 used DM, 62 used FHD, and 64 used no ADM. The total complication rate with AlloDerm was 22% [95% confidence interval (CI), 11-34], with DM was 15% (95% CI, 8-21), and with FHD was 18% (95% CI, 8-28) (P=0.47). Infectious complication rates for AlloDerm, DM, and FHD were equal at 10% (P=0.97). The total complication rate of all ADM reconstructions as a grouped cohort was 17% compared to 11% without ADM (P=0.48). The overall incidence of infectious complications with ADM was 10% compared to 2% without ADM (P=0.09). There is no difference in the clinically significant overall complication rate or incidence of infection between AlloDerm, DM, and FHD. Isolating infectious complications, there is a trend toward increased incidence with ADM compared to reconstructions without.
authors.affiliation: Division of Plastic Surgery, The Pennsylvania State University, College of Medicine, Penn State Milton S. Hershey Medicine Center, Hershey, PA 17033-0850, USA. sbrooke@hmc.psu.edu
authors.forename: Sebastian
authors.initials: S
authors.lastname: Brooke
authors.forename: John
authors.initials: J
authors.lastname: Mesa
authors.forename: Mehmet
authors.initials: M
authors.lastname: Uluer
authors.forename: Brett
authors.initials: B
authors.lastname: Michelotti
authors.forename: Kurtis
authors.initials: K
authors.lastname: Moyer
authors.forename: Rogerio I
authors.initials: RI
authors.lastname: Neves
authors.forename: Donald
authors.initials: D
authors.lastname: Mackay
authors.forename: John
authors.initials: J
authors.lastname: Potochny
mesh_terms: D062088:Acellular Dermis; D000328:Adult; D000368:Aged; D019928:Breast Implantation / Q000379:methods*; D001943:Breast Neoplasms / Q000601:surgery; D003094:Collagen; D005260:Female; D006801:Humans; D015994:Incidence; D008408:Mastectomy; D008875:Middle Aged; D010359:Patient Readmission; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D016038:Skin Transplantation; D015626:Tissue Expansion
chemical_list: C440568:Alloderm; D003094:Collagen