title: Short-Term Complications Associated With Acellular Dermal Matrix-Assisted Direct-to-Implant Breast Reconstruction.
abstract: BACKGROUND
  Although direct-to-implant breast reconstruction is a more concise procedure than 2-stage expander/implant reconstruction, it is less frequently performed. Skeptics of direct-to-implant reconstruction cite risk of postoperative complications as a reason for its rejection. To determine whether these perceptions are valid, we evaluated our 13-year experience of acellular dermal matrix (ADM)-assisted, direct-to-implant breast reconstruction. We report complication and reoperation rates associated with this technique as well as predictors for these outcomes.
  
  
  METHODS
  This retrospective study included all patients who underwent immediate, ADM-assisted, direct-to-implant, breast reconstruction from December 2001 to May 2014 at 2 practices. Postoperative complications, defined as those occurring within the first 12 months after reconstructive surgery, were evaluated. Univariate/multivariate analyses were performed to determine the influence of patient-, breast-, and surgery-related characteristics on the development of complications.
  
  
  RESULTS
  A total of 1584 breast reconstructions (721 bilateral, 142 unilateral) in 863 patients were performed; 35% were oncologic, and 65% were prophylactic reconstructions. Complication rate was 8.6% and included skin necrosis (5.9%), infection (3.0%), implant loss (2.9%), seroma (1.1%), and hematoma (0.9%). Reoperative rate in breasts with complications was 3.2%. Age 50 years or older, smoking, nonnipple-sparing mastectomy, and implant size of 600 mL or greater strongly predicted the development of complications (P < 0.001).
  
  
  CONCLUSIONS
  Our cumulative 13-year experience demonstrates that immediate, ADM-assisted, direct-to-implant breast reconstruction is safe, effective, and reliable. Complication and reoperation rates are less than 10% and are comparable to those reported for 2-stage procedures in the published literature.
authors: From the *Revalla Plastic Surgery, Littleton, CO; †Ashikari Breast Center; and ‡New York Group for Plastic Surgery, LLP, New York, NY.
authors: Lisa M
authors: LM
authors: Hunsicker
authors: Andrew Y
authors: AY
authors: Ashikari
authors: Colleen
authors: C
authors: Berry
authors: R Michael
authors: RM
authors: Koch
authors: C Andrew
authors: CA
authors: Salzberg
mesh_terms: D062088:Acellular Dermis; D000328:Adult; D000368:Aged; D019928:Breast Implantation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors