title: The impact of acellular dermal matrix on tissue expander/implant loss in breast reconstruction: an analysis of the tracking outcomes and operations in plastic surgery database.
abstract: BACKGROUND
  Use of acellular dermal matrix in breast reconstruction has been associated with increased complications. However, existing studies are generally small, from single centers, and underpowered to control for confounding using regression techniques. Here, the Tracking Outcomes and Operations in Plastic Surgery database was used to examine the effect of acellular dermal matrix on expander/implant loss when controlling for other confounders.
  
  
  METHODS
  Analysis was limited to patients having tissue expander or implant-based breast reconstruction. Surgeon-reported data, International Classification of Diseases, Ninth Edition codes, and Current Procedural Terminology codes were used to identify independent variables. The dependent variable of interest was 30-day rates of tissue expander or implant loss. Bivariate statistics were performed. Multivariable logistic regression identified independent predictors of expander/implant loss when controlling for other confounders.
  
  
  RESULTS
  Data were available for 14,249 patients. The overall rate of expander/implant loss was 2.05 percent. Bivariate analysis demonstrated acellular dermal matrix was associated with an absolute increase in expander/implant loss of 0.7 percent (1.88 percent versus 2.58 percent, p = 0.012). The regression model demonstrated that rising body mass index, current smoking, and presence of diabetes were each independent predictors of expander/implant loss. When controlling for all other identified confounders, use of acellular dermal matrix was associated with a significant increase in expander/implant loss (odds ratio, 1.42; 95 percent confidence interval, 1.04 to 1.94; p = 0.026).
  
  
  CONCLUSIONS
  Thirty-day risk for expander/implant loss after tissue expander or implant-based breast reconstruction was 2.05 percent. Use of acellular dermal matrix was associated with a 0.7 percent absolute risk increase for expander/implant loss.
  
  
  METHODS
  Risk, III.
authors.affiliation: Ann Arbor, Mich.; and Chicago, Ill. From the Section of Plastic Surgery, University of Michigan; and the Division of Plastic Surgery, University of Illinois-Chicago.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Pannucci
authors.forename: Anuja K
authors.initials: AK
authors.lastname: Antony
authors.forename: Edwin G
authors.initials: EG
authors.lastname: Wilkins
mesh_terms: D062088:Acellular Dermis / Q000009:adverse effects*; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016462:Mammaplasty / Q000379:methods*; D008499:Medical Records; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D013518:Surgery, Plastic / Q000706:statistics & numerical data*; D013997:Time Factors; D015625:Tissue Expansion Devices; D014481:United States / Q000453:epidemiology