title: An algorithmic approach for selective acellular dermal matrix use in immediate two-stage breast reconstruction: indications and outcomes.
abstract: BACKGROUND
  Acellular dermal matrix use has gained widespread acceptance--despite higher material costs--because of its ease of use and potential for enhanced cosmesis. The authors developed a resource-sensitive algorithm for selective acellular dermal matrix use with indications and contraindications based on body mass index, breast size, radiation therapy, flap vascularity, and pectoralis anatomy.
  
  
  METHODS
  The algorithm incorporates preoperative and intraoperative decision points. Complication rates and aesthetic scores were compared for procedures performed before and after adoption of the algorithm. Multiple logistic regression was used to determine the independent influence of the algorithm on postoperative outcomes.
  
  
  RESULTS
  One hundred ninety-three breasts underwent reconstruction before and 179 underwent reconstruction after implementation of the algorithm. Overall complication rates did not differ between the cohorts (22.8 percent versus 20.7 percent; p=0.138). After adjusting for potential confounders, the algorithm did not significantly affect the incidence of infection, seroma, flap necrosis, explantation, or overall complications (all p>0.05). Aesthetic scores were not affected (2.75 of 4 versus 3.03 of 4; p=0.138). Acellular dermal matrix use decreased from 84 percent to 36 percent, resulting in a materials cost savings of $270,000 over the study period.
  
  
  CONCLUSIONS
  This algorithm obviated placement of acellular dermal matrix in an estimated 48 percent of immediate tissue-expander reconstructions. Patients treated after adoption of this algorithm experienced similar complication rates and aesthetic outcomes as those who underwent reconstruction before. The authors' preliminary outcomes demonstrate that evidence-based measures can be taken to selectively use acellular dermal matrix without a concomitant worsening of patient outcomes.
  
  
  METHODS
  Therapeutic, III.
authors: Chicago, Ill. From the Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine.
authors: Sumanas W
authors: SW
authors: Jordan
authors: Nima
authors: N
authors: Khavanin
authors: Neil A
authors: NA
authors: Fine
authors: John Y S
authors: JYS
authors: Kim
mesh_terms: D062088:Acellular Dermis / Q000191:economics / Q000706:statistics & numerical data; D000328:Adult; D000465:Algorithms; D001943:Breast Neoplasms / Q000601:surgery; D002641:Chicago; D000075202:Contraindications; D003661:Decision Support Techniques; D004954:Esthetics; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D016462:Mammaplasty / Q000191:economics / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies