title: Incidence of Seromas and Infections Using Fenestrated versus Nonfenestrated Acellular Dermal Matrix in Breast Reconstructions.
abstract: BACKGROUND
  Acellular dermal matrices (ADMs) provide clinical benefits in breast reconstruction but have been associated with increased postoperative complications, most frequently seromas. Fenestration of the ADM before insertion into the reconstructed breast may reduce the incidence of postoperative complications. In this retrospective analysis, postoperative complications were assessed after breast reconstruction with or without fenestrated ADMs.
  
  
  METHODS
  Patients who underwent immediate 2-staged implant breast reconstructions using ADM at a single center were assessed. The number of reconstructed breasts was stratified by ADM fenestration status and ADM type. The incidence of seroma, infection, extrusion, and explantation, and cosmetic score, was compared within the 2 stratified groups. A multivariable regression was performed to identify independent risk factors associated with these complications and aesthetic outcome.
  
  
  RESULTS
  In total, data from 450 patients who had 603 breast reconstructions using either AlloDerm or FlexHD demonstrated a significantly higher incidence of seroma with nonfenestrated ADMs (20%) versus fenestrated ADMs (11%; P = 0.0098). Rates of infection and explantation, and cosmetic score, were not influenced by fenestration status. In the multivariable analysis, ADM fenestration remained a significant protective factor for seroma formation. FlexHD also yielded a lower incidence of extrusion (P = 0.0031) and a higher cosmetic score (P = 0.0466) compared with AlloDerm after adjusting for other risk factors.
  
  
  CONCLUSIONS
  The results of this study support ADM fenestration for reduction of seroma incidence in breast reconstruction, without affecting cosmetic results. Additionally, the choice of ADM may reduce extrusion incidence and improve aesthetic outcomes.
authors.affiliation: Northern Westchester Surgical Services, Mount Kisco, N.Y.; Northern Westchester Hospital, Mt. Kisco, N.Y.
authors.forename: David A
authors.initials: DA
authors.lastname: Palaia
authors.affiliation: Northern Westchester Surgical Services, Mount Kisco, N.Y.; Northern Westchester Hospital, Mt. Kisco, N.Y.
authors.forename: Karen S
authors.initials: KS
authors.lastname: Arthur
authors.affiliation: Northern Westchester Surgical Services, Mount Kisco, N.Y.; Northern Westchester Hospital, Mt. Kisco, N.Y.
authors.forename: Anthony C
authors.initials: AC
authors.lastname: Cahan
authors.affiliation: Northern Westchester Surgical Services, Mount Kisco, N.Y.; Northern Westchester Hospital, Mt. Kisco, N.Y.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Rosenberg