title: Immediate breast reconstruction with acellular dermal matrix: factors affecting outcome.
abstract: BACKGROUND
  The use of acellular dermal matrix (ADM) for coverage of the lower pole in immediate implant-based breast reconstruction has changed surgeons' practice. We present our experience using a porcine ADM (Strattice), focusing on short-term outcomes, patient selection, and technique adaptations that may influence outcome.
  
  
  METHODS
  A two-center, retrospective, cohort study was performed from December 2008 to October 2012 at Guy's and St. Thomas' Hospitals, London, and Clinic Pyramide, Zürich. The study period was divided into two periods: Period 1 which spanned from December 2008 to October 2010 and Period 2 from January 2011 to October 2012 wherein technique adaptations were introduced. Short-term complications after reconstructive surgery were compared between Periods 1 and 2.
  
  
  RESULTS
  A total of 149 patients underwent 200 reconstructions (110 one-stage and 90 two-stage) following oncologic (134 breasts) or prophylactic (66 breasts) mastectomy. The mean follow-up was 22.2 months. The total complication rate was 32.5%, including infection, 11.5%; hematoma, 5%; seroma, 10.5%; skin necrosis, 3.5%; and serious wound breakdowns with implant exposure, 1.5%. Complications resulted in 3% requiring an early exchange of implant/expander and in 12.5% requiring explantation. A significant reduction in total complications, infection, implant exposure, and implant loss were noted in Period 2. Multivariate analysis showed time period of surgery (Period 1), single-stage reconstruction, and patient characteristics (mastectomy weight>600 g, or body mass index (BMI)>30, or smoking) to be statistically significant risk factors for the development of postoperative complications. Neoadjuvant chemotherapy showed a trend towards higher complication rates.
  
  
  CONCLUSIONS
  The high rate of early complications in this study was mostly related to patient characteristics and learning curves and highlights the importance of patient selection and technique principles in optimizing the outcome.
authors.affiliation: Department of Plastic & Reconstructive Surgery, Guy's and St. Thomas Hospital, London, UK; Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland. Electronic address: Alessia.Lardi@usb.ch.
authors.forename: Alessia M
authors.initials: AM
authors.lastname: Lardi
authors.affiliation: Department of Plastic & Reconstructive Surgery, Guy's and St. Thomas Hospital, London, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Ho-Asjoe
authors.affiliation: Department of Plastic & Reconstructive Surgery, Guy's and St. Thomas Hospital, London, UK.
authors.forename: Pari-Naz
authors.initials: PN
authors.lastname: Mohanna
authors.affiliation: Department of Plastic & Reconstructive Surgery, Guy's and St. Thomas Hospital, London, UK; Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland; Center for Plastic Surgery, Clinic Pyramide at the Lake, Zürich, Switzerland.
authors.forename: Jian
authors.initials: J
authors.lastname: Farhadi
mesh_terms: D062088:Acellular Dermis; D000328:Adult; D000368:Aged; D000818:Animals; D015992:Body Mass Index; D018427:Breast Implants; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D015331:Cohort Studies; D006801:Humans; D059032:Learning Curve; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D063868:Patient Outcome Assessment; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects
keywords: Acellular dermis; Breast reconstruction; Complications; Implant-based; Learning curve; Strattice