title: Direct-to-Implant Breast Reconstruction without the Use of an Acellular Dermal Matrix Is Cost Effective and Oncologically Safe.
abstract: BACKGROUND
  Direct-to-implant breast reconstruction is a predictable, reliable, and cost-effective reconstruction. Most units performing direct-to-implant reconstructions recommend the use of an acellular dermal matrix or a mesh to reinforce the lower pole of the breast reconstruction.
  
  
  METHODS
  Two hundred seventy-two consecutive patients with 488 immediate direct-to-implant breast reconstructions performed in a 34-month period are included in this group. Mean follow-up of this group is 35 months.
  
  
  RESULTS
  Four hundred eight reconstructions were performed through a lazy-S mastectomy, and 80 were performed through a Wise pattern mastectomy. Two local recurrences occurred. Minor complications accounted for 5.5 percent (n = 27): seromas, 3.4 percent (n = 17); wound healing problems, 0.6 percent (n = 3); and grade 2 capsular contracture, 1.4 percent (n = 7). Major complications accounted for 4.3 percent (n = 21): infection, 0.8 percent (n = 4); prosthetic loss, 0.4 percent (n = 2); hematoma, 0.4 percent (n = 2); and wounds requiring débridement, 2 percent (n = 10). The additional cost of acellular dermal matrix is dependent on manufacturer and size, but increases the cost of the procedure by 35.5 to 47.7 percent.
  
  
  CONCLUSIONS
  This reconstruction method compares very favorably with published data from other units as far as early and late complications and cosmetic outcome are concerned. It has a complication rate similar to that of reconstructions using an acellular dermal matrix and is more cost effective.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Johannesburg, South Africa.|From the University of the Witwatersrand and Milpark Breast Care Centre of Excellence.
authors.forename: L Charles J
authors.initials: LCJ
authors.lastname: Serrurier
authors.affiliation: Johannesburg, South Africa.|From the University of the Witwatersrand and Milpark Breast Care Centre of Excellence.
authors.forename: Sarah
authors.initials: S
authors.lastname: Rayne
authors.affiliation: Johannesburg, South Africa.|From the University of the Witwatersrand and Milpark Breast Care Centre of Excellence.
authors.forename: Marisse
authors.initials: M
authors.lastname: Venter
authors.affiliation: Johannesburg, South Africa.|From the University of the Witwatersrand and Milpark Breast Care Centre of Excellence.
authors.forename: Carol-Ann
authors.initials: CA
authors.lastname: Benn
mesh_terms: D062088:Acellular Dermis; D000293:Adolescent; D000328:Adult; D000368:Aged; D019928:Breast Implantation / Q000191:economics*; D001943:Breast Neoplasms / Q000601:surgery*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000191:economics / Q000379:methods; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult