title: Uneventful versus Successful Reconstruction and Outcome Pathways in Implant-Based Breast Reconstruction with Acellular Dermal Matrices.
abstract: BACKGROUND
  Meaningful data to help guide resource allocation for staged tissue expander/implant-based breast reconstruction are currently lacking. The authors seek to differentiate uneventful from successful reconstruction and identify common outcome pathways and factors that portend a deviation from an uneventful, two-stage, two-operation course.
  
  
  METHODS
  A retrospective analysis of expander/implant reconstructions with or without acellular dermal matrix (2003 to 2009) was performed. Related postreconstructive events (including mastectomy flap necrosis, seroma, wound dehiscence, cellulitis, explantation, hematoma, and capsular revisions) were assessed for 2 years. Uneventful reconstruction was defined as exchange to breast implant within 2 years of tissue expander placement without complications, whereas successful reconstruction was defined as exchange to breast implant within 2 years with or without complications. Factors affecting reconstructive success were analyzed, and patterns of postreconstructive events were summarized as outcome pathways.
  
  
  RESULTS
  Four hundred thirteen patients (295 with acellular dermal matrix and 118 without), with 602 breasts (432 with acellular dermal matrix and 170 without) underwent reconstruction. Forty-six percent of patients (48 percent with acellular dermal matrix and 40 percent without), experienced uneventful reconstruction. Reconstructive success was achieved in 337 patients (82 percent; 82.0 percent with acellular dermal matrix and 80.5 percent without), with reconstructive failure occurring in 58 patients. Multiple logistic regression analyses determined that cellulitis, seroma, and skin necrosis (OR, 15.8, 7.7, and 8.4, respectively) were highly predictive of reconstructive failure. The authors identified 10 distinct pathways experienced by tissue expander/implant patients that were characterized by specific postreconstructive events.
  
  
  CONCLUSIONS
  The present study will facilitate discussions among patients, providers, and payers by providing a framework for understanding the myriad outcome pathways in implant-based reconstruction.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: St. Louis, Mo.; and La Canada, Calif.|From the Division of Plastic and Reconstructive Surgery and the Department of Surgery, Washington University School of Medicine; and Strategic Health Resources.
authors.forename: Ali A
authors.initials: AA
authors.lastname: Qureshi
authors.affiliation: St. Louis, Mo.; and La Canada, Calif.|From the Division of Plastic and Reconstructive Surgery and the Department of Surgery, Washington University School of Medicine; and Strategic Health Resources.
authors.forename: Kristen P
authors.initials: KP
authors.lastname: Broderick
authors.affiliation: St. Louis, Mo.; and La Canada, Calif.|From the Division of Plastic and Reconstructive Surgery and the Department of Surgery, Washington University School of Medicine; and Strategic Health Resources.
authors.forename: Jessica
authors.initials: J
authors.lastname: Belz
authors.affiliation: St. Louis, Mo.; and La Canada, Calif.|From the Division of Plastic and Reconstructive Surgery and the Department of Surgery, Washington University School of Medicine; and Strategic Health Resources.
authors.forename: Susan
authors.initials: S
authors.lastname: Funk
authors.affiliation: St. Louis, Mo.; and La Canada, Calif.|From the Division of Plastic and Reconstructive Surgery and the Department of Surgery, Washington University School of Medicine; and Strategic Health Resources.
authors.forename: Nancy
authors.initials: N
authors.lastname: Reaven
authors.affiliation: St. Louis, Mo.; and La Canada, Calif.|From the Division of Plastic and Reconstructive Surgery and the Department of Surgery, Washington University School of Medicine; and Strategic Health Resources.
authors.forename: Keith E
authors.initials: KE
authors.lastname: Brandt
authors.affiliation: St. Louis, Mo.; and La Canada, Calif.|From the Division of Plastic and Reconstructive Surgery and the Department of Surgery, Washington University School of Medicine; and Strategic Health Resources.
authors.forename: Marissa M
authors.initials: MM
authors.lastname: Tenenbaum
authors.affiliation: St. Louis, Mo.; and La Canada, Calif.|From the Division of Plastic and Reconstructive Surgery and the Department of Surgery, Washington University School of Medicine; and Strategic Health Resources.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Margenthaler
authors.affiliation: St. Louis, Mo.; and La Canada, Calif.|From the Division of Plastic and Reconstructive Surgery and the Department of Surgery, Washington University School of Medicine; and Strategic Health Resources.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Aft
authors.affiliation: St. Louis, Mo.; and La Canada, Calif.|From the Division of Plastic and Reconstructive Surgery and the Department of Surgery, Washington University School of Medicine; and Strategic Health Resources.
authors.forename: Terence M
authors.initials: TM
authors.lastname: Myckatyn
mesh_terms: D062088:Acellular Dermis; D018427:Breast Implants; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies; D015625:Tissue Expansion Devices; D016896:Treatment Outcome