title: Alternatives to Acellular Dermal Matrix: Utilization of a Gore DualMesh Sling as a Cost-Conscious Adjunct for Breast Reconstruction.
abstract: Objective: This study seeks an alternative to acellular dermal matrix in 2-staged breast reconstruction while minimizing cost. It was hypothesized that use of a Gore DualMesh would allow for similar intraoperative tissue expander fill volumes, time to second-stage reconstruction, and number of postoperative fills compared with acellular dermal matrix at only a fraction of the expense.Methods:Retrospective analysis comparing Gore DualMesh (59 breasts, 34 patients), acellular dermal matrix (13 breasts, 8 patients), and total muscle coverage (25 breasts, 14 patients) for postmastectomy breast reconstruction was performed. Time to second-stage reconstruction, number of expansions, and relative initial fill volumes were compared between the 3 groups. Secondarily, complication rates were also considered, including seroma, infection, expander/implant explantation, removal of mesh, and capsular contracture. Statistical analysis was performed utilizing the Fisher exact test and the χ2test for categorical variables and the Mann-WhitneyUtest for continuous variables.Results:Relative initial fill volumes, number of expansions, and time to second-stage reconstruction showed no statistical difference between the acellular dermal matrix and Gore DualMesh groups (P= .494,P= .146, andP= .539, respectively). Furthermore, the Gore DualMesh group underwent significantly fewer fills (P< .001) and had a higher relative initial fill volume (P< .001) than the total muscle coverage group. The additional cost per breast as a result of including DualMesh was on average $385 versus $4287 for acellular dermal matrix. Complication rates were similar between all 3 groups without statistically significant differences.Conclusions:Gore DualMesh represents a safe alternative to acellular dermal matrix for breast reconstruction with similar aesthetic results in certain patients at a fraction of the cost.
authors.affiliation: Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Mo.
authors.forename: Jacob N
authors.initials: JN
authors.lastname: Grow
authors.affiliation: Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Mo.
authors.forename: James
authors.initials: J
authors.lastname: Butterworth
authors.affiliation: Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minn.
authors.forename: Paul
authors.initials: P
authors.lastname: Petty
keywords: acellular dermal matrix; breast reconstruction; cost; mesh; tissue expansion