title: The BREASTrial: stage I. Outcomes from the time of tissue expander and acellular dermal matrix placement to definitive reconstruction.
abstract: BACKGROUND
  Use of acellular dermal matrix in tissue expander breast reconstruction has become a popular adjunct to the total submuscular technique. The question remains as to which matrix, if any, is ideal for breast reconstruction.
  
  
  METHODS
  A randomized trial was conducted to analyze outcomes of immediate staged tissue expander breast reconstruction using either AlloDerm or DermaMatrix. The impact of obesity, radiation, and chemotherapy on complications and biointegration of matrix was investigated. The trial was divided into three stages, with stage I results reported here.
  
  
  RESULTS
  One hundred twenty-eight patients (199 breasts) were randomized equally over 2.5 years. Most patients were white, healthy nonsmokers. The overall complication rate was 36.2 percent; half of the complications were minor. The AlloDerm and DermaMatrix groups had similar rates of complications (33.6 percent versus 38.8 percent; p = 0.52), consisting mostly of skin necrosis (17.8 percent versus 21.4 percent; p = 0.66) and infections (13.9 percent versus 16.3 percent; p = 0.29), both of which led to tissue expander losses (5 percent versus 11.2 percent; p = 0.11). The AlloDerm group required less time for completion of expansion (42 days versus 70 days; p < 0.001). Obesity was associated with poor matrix biointegration and a longer drain time, both of which were associated with higher complication rates.
  
  
  CONCLUSIONS
  The Breast Reconstruction Evaluation Using Acellular Dermal Matrix as a Sling Trial is the largest randomized trial to date in matrix breast reconstruction and emphasizes the importance of careful patient and allograft selection to minimize complications.
  
  
  METHODS
  Therapeutic, II.
authors.affiliation: Salt Lake City, Utah; and Springfield, Ill. From the Division of Plastic and Reconstructive Surgery, the Department of Surgery, the Division of Epidemiology, Department of Internal Medicine, and the Department of Pathology, University of Utah School of Medicine; and the Institute for Plastic Surgery, Southern Illinois University School of Medicine.
authors.forename: Shaun D
authors.initials: SD
authors.lastname: Mendenhall
authors.forename: Layla A
authors.initials: LA
authors.lastname: Anderson
authors.forename: Jian
authors.initials: J
authors.lastname: Ying
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Boucher
authors.forename: Ting
authors.initials: T
authors.lastname: Liu
authors.forename: Leigh A
authors.initials: LA
authors.lastname: Neumayer
authors.forename: Jayant P
authors.initials: JP
authors.lastname: Agarwal
mesh_terms: D062088:Acellular Dermis; D003094:Collagen; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D017768:Skin, Artificial; D015626:Tissue Expansion; D016896:Treatment Outcome
chemical_list: C440568:Alloderm; D003094:Collagen