title: Does Acellular Dermal Matrix Thickness Affect Complication Rate in Tissue Expander Based Breast Reconstruction?
abstract: Background. While the benefits of using acellular dermal matrices (ADMs) in breast reconstruction are well described, their use has been associated with additional complications. The purpose of this study was to determine if ADM thickness affects complications in breast reconstruction. Methods. A retrospective chart review was performed including all tissue expander based breast reconstructions with AlloDerm (LifeCell, Branchburg, NJ) over 4 years. We evaluated preoperative characteristics and assessed postoperative complications including seroma, hematoma, infection, skin necrosis, and need for reintervention. We reviewed ADM thickness and time to Jackson-Pratt (JP) drain removal. Results. Fifty-five patients underwent 77 ADM-associated tissue expander based breast reconstructions, with average age of 48.1 years and average BMI of 25.9. Average ADM thickness was 1.21 mm. We found higher complication rates in the thick ADM group. Significant associations were found between smokers and skin necrosis (p < 0.0001) and seroma and prolonged JP drainage (p = 0.0004); radiated reconstructed breasts were more likely to suffer infections (p = 0.0085), and elevated BMI is a significant predictor for increased infection rate (p = 0.0037). Conclusion. We found a trend toward increased complication rates with thicker ADMs. In the future, larger prospective studies evaluating thickness may provide more information.
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Houston Methodist Hospital, Medical Office Building, 118400 Katy Freeway, Suite 500, Houston, TX 77094, USA.
authors.forename: Jessica F
authors.identifier: 0000-0002-9135-1943
authors.initials: JF
authors.lastname: Rose
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Houston Methodist Hospital, Medical Office Building, 118400 Katy Freeway, Suite 500, Houston, TX 77094, USA.
authors.forename: Sarosh N
authors.identifier: 0000-0002-2213-5980
authors.initials: SN
authors.lastname: Zafar
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Houston Methodist Hospital, Medical Office Building, 118400 Katy Freeway, Suite 500, Houston, TX 77094, USA.
authors.forename: Warren A
authors.identifier: 0000-0002-8273-3747
authors.initials: WA
authors.lastname: Ellsworth Iv