title: Use of Acellular Dermal Matrix in Postmastectomy Breast Reconstruction: Are All Acellular Dermal Matrices Created Equal?
abstract: BACKGROUND
  AlloDerm and FlexHD are two types of acellular dermal matrices commonly used in implant-based reconstruction. Although the use of acellular dermal matrix has revolutionized immediate breast reconstruction in the setting of breast cancer, it remains unclear which type of acellular dermal matrix is best. The purpose of this retrospective cohort study was to compare postoperative complication rates between these two types of acellular dermal matrix.
  
  
  METHODS
  The authors reviewed the records of all patients who underwent implant-based breast reconstruction at their institution between 1998 and 2013. Dependent variables of seroma, hematoma, infection, delayed wound healing, implant exposure, and return to the operating room for management of complications were recorded.
  
  
  RESULTS
  A total of 309 consecutive patients were identified. Of these, AlloDerm was used in 123 patients (39.8 percent) and FlexHD was used in 186 patients (60.2 percent). Most patients in the authors' cohort underwent immediate reconstruction [n = 288 (93.2 percent)], with a mean follow-up of 20.0 months. Patients receiving AlloDerm were half as likely to have major infections compared with patients receiving FlexHD (OR, 0.50; 95 percent CI, 0.16 to 1.00; p < 0.05). The rates of other complications were similar between the two groups.
  
  
  CONCLUSIONS
  There are significantly increased odds of a major infection in patients who undergo implant-based breast reconstruction using FlexHD compared with AlloDerm.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Ann Arbor, Mich. From the Section of Plastic Surgery, Department of Surgery, Department of Biostatistics, University of Michigan Health System, and the University of Michigan Medical School.
authors.forename: Kavitha
authors.initials: K
authors.lastname: Ranganathan
authors.forename: Katherine B
authors.initials: KB
authors.lastname: Santosa
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Lyons
authors.forename: Simanjit
authors.initials: S
authors.lastname: Mand
authors.forename: Minqiang
authors.initials: M
authors.lastname: Xin
authors.forename: Kelley
authors.initials: K
authors.lastname: Kidwell
authors.forename: David L
authors.initials: DL
authors.lastname: Brown
authors.forename: Edwin G
authors.initials: EG
authors.lastname: Wilkins
authors.forename: Adeyiza O
authors.initials: AO
authors.lastname: Momoh
mesh_terms: D062088:Acellular Dermis; D000328:Adult; D000368:Aged; D019928:Breast Implantation / Q000379:methods*; D001943:Breast Neoplasms / Q000601:surgery; D003094:Collagen; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008408:Mastectomy; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control
chemical_list: C440568:Alloderm; C582618:FlexHD; D003094:Collagen