title: Minimizing complications with the use of acellular dermal matrix for immediate implant-based breast reconstruction.
abstract: BACKGROUND
  Acellular dermal matrix (ADM) use in implant-based breast reconstruction has been associated with higher rates of postoperative seroma and infection. This follow-up study was performed to determine whether specific modifications in technique are associated with a reduction in the rate of complications.
  
  
  METHODS
  The authors performed a retrospective analysis of immediate ADM-assisted implant-based breast reconstructions performed by the lead author (Y.C.) during an 18-month period after instituting specific modifications to prevent seroma. These included draining both the submastectomy and sub-ADM planes, lowering the threshold for drain removal, and addition of postoperative soft compression dressings and surgical bras. A total of 179 implant-based reconstructions were evaluated for rates of complications, including infection, hematoma, seroma, and skin flap necrosis. These were compared to results of a series of 150 similar procedures performed by the lead author before institution of the procedural modifications described.
  
  
  RESULTS
  Seroma rate decreased from 18.6% to 4.7% (P = 0.0022), and major infection rate decreased from 7% to 1.9% (0.0250).
  
  
  CONCLUSIONS
  Although implant-based breast reconstruction using ADM has been associated with increased seroma and possible infection rates, the use of specific clinical practices designed to prevent seroma has minimized our rate of these postoperative complications.
authors.affiliation: From the *Brigham and Women's Hospital, Boston, MA; †Georgetown University Hospital, Washington, DC; ‡Vanderbilt University Medical Center, Nashville, TN; and §Brigham and Women's Faulkner Hospital, Boston, MA.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Ganske
authors.forename: Kapil
authors.initials: K
authors.lastname: Verma
authors.forename: Heather
authors.initials: H
authors.lastname: Rosen
authors.forename: Elof
authors.initials: E
authors.lastname: Eriksson
authors.forename: Yoon S
authors.initials: YS
authors.lastname: Chun
mesh_terms: D062088:Acellular Dermis; D000328:Adult; D019928:Breast Implantation / Q000009:adverse effects / Q000379:methods*; D018427:Breast Implants / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D012189:Retrospective Studies; D049291:Seroma / Q000209:etiology / Q000517:prevention & control*; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*; D015626:Tissue Expansion / Q000379:methods*; D016896:Treatment Outcome