title: Outcome of the use of acellular-dermal matrix to assist implant-based breast reconstruction in a single centre.
abstract: BACKGROUND
  The use of acellular dermal matrix (ADM) has transformed the technique of implant-based breast reconstruction. It offers the option of a one-stage procedure and is felt to have benefits in cosmetic outcome but the medium and long-term outcomes are unknown.
  
  
  METHODS
  All cases where ADM was used in a breast reconstructive procedure in the Edinburgh Breast Unit from its initial use on 7/7/2008 to 31/7/2012 were reviewed retrospectively. Follow up was completed to 30/11/2012.
  
  
  RESULTS
  147 patients received 232 sheets of ADM (156 Strattice, 73 Permacol and 3 Alloderm). Mean follow up was 687 days. In 40 cases unplanned implant explantation occurred (17.2% or 27.2% of patients). 7 of 27 (25.9%) patients requiring adjuvant therapy had this delayed due to problems with the reconstruction. 30 of 80 patients (37.5%) undergoing unilateral surgery have undergone contralateral surgery. Implant loss varied significantly with smoking (34.6% loss rate in smokers vs 13.2% in non-smokers, p = 0.001), with radiotherapy (28.1% loss rate vs 13.8% with no radiotherapy, p = 0.001) and with incision type. There was no statistically significant variation by operating surgeon, type of ADM used, chemotherapy use, patient weight, breast weight or nipple preservation. Patients underwent a mean of 1.54 further operations (range 0-7).
  
  
  CONCLUSIONS
  While offering potential cosmetic and financial benefits, the use of ADM with implant-based reconstructions has a significant rate of implant loss, further surgery and potential delay in adjuvant therapy. These must be considered when planning treatment and consenting patients.
authors.affiliation: Edinburgh Breast Unit, Western General Hospital, Edinburgh EH4 2XU, United Kingdom. Electronic address: matthew.barber@luht.scot.nhs.uk.
authors.forename: M D
authors.initials: MD
authors.lastname: Barber
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh Medical School, Teviot Place, Edinburgh EH8 9AG, United Kingdom.
authors.forename: L
authors.initials: L
authors.lastname: Williams
authors.affiliation: Edinburgh Breast Unit, Western General Hospital, Edinburgh EH4 2XU, United Kingdom.
authors.forename: E D C
authors.initials: ED
authors.lastname: Anderson
authors.affiliation: Edinburgh Breast Unit, Western General Hospital, Edinburgh EH4 2XU, United Kingdom.
authors.forename: G T
authors.initials: GT
authors.lastname: Neades
authors.affiliation: Department of Plastic Surgery, St John's Hospital, Livingston EH54 6PP, United Kingdom.
authors.forename: C
authors.initials: C
authors.lastname: Raine
authors.affiliation: Edinburgh Breast Unit, Western General Hospital, Edinburgh EH4 2XU, United Kingdom.
authors.forename: O
authors.initials: O
authors.lastname: Young
authors.affiliation: Edinburgh Breast Unit, Western General Hospital, Edinburgh EH4 2XU, United Kingdom.
authors.forename: D
authors.initials: D
authors.lastname: Kulkarni
authors.affiliation: Edinburgh Breast Unit, Western General Hospital, Edinburgh EH4 2XU, United Kingdom.
authors.forename: I
authors.initials: I
authors.lastname: Young
authors.affiliation: Edinburgh Breast Unit, Western General Hospital, Edinburgh EH4 2XU, United Kingdom.
authors.forename: J M
authors.initials: JM
authors.lastname: Dixon
mesh_terms: D062088:Acellular Dermis; D000328:Adult; D000368:Aged; D019928:Breast Implantation / Q000009:adverse effects / Q000379:methods*; D018427:Breast Implants; D001943:Breast Neoplasms / Q000601:surgery*; D002277:Carcinoma / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D003094:Collagen / Q000627:therapeutic use; D020878:Device Removal / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D011475:Prosthesis Failure; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012907:Smoking / Q000453:epidemiology; D061665:Time-to-Treatment; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: C440568:Alloderm; C422414:Permacol; C568444:strattice; D003094:Collagen
keywords: Acellular dermal matrix; Breast; Breast reconstruction; Mastectomy; Surgical complications