Introduction: AlloDerm is an acellular, cryopreserved, dermal matrix lacking antigenic stimuli. As such, its use has been promoted in the setting of implant-based postmastectomy reconstruction in order to re-establish a soft-tissue layer between the overlying mastectomy skin and underlying prosthesis. In the setting of immediate, implant-based reconstruction, however, both infectious complications and wound healing problems can have negative consequences. Not only can these outcomes necessitate the explantation of a permanent prosthesis, they can, more importantly, delay the administration of adjuvant therapy for breast cancer. A critical analysis of complications following immediate, implant-based reconstruction with AlloDerm is thus necessitated.
The purpose of this study is to: i) determine the feasibility of using AlloDerm in immediate, tissue expander/implant (TE/I) reconstruction; and, ii) to determine incidence of peri-operative complications following AlloDerm implantation in the setting of postmastectomy, TE/I reconstruction.
Methods: All patients who had immediate, TE/I reconstruction from January 2004 - December 2005 with and without the use implantable AlloDerm were identified. AlloDerm was used in this setting in lieu of serratus fascia +/- muscle elevation. Demographic, reconstructive and complication data was retrieved from a prospectively-maintained, clinical database. A matched, retrospective cohort study was performed. Patients were matched 1:1 on the basis of: age (+/- 3 years), procedure performed, timing of procedure and history of neoadjuvant radiotherapy and/or chemotherapy. The primary outcome measure was the development of a peri-operative complication. Pairwise comparisons were performed using the McNemar's c2 test for categorical variables. Indications for the use of AlloDerm and surgical techniques were reviewed.
Results: From 2004-2005, 20 patients had 29 immediate, TE/I reconstructions using implantable AlloDerm. Mean patient age was 47.0 years. Neo-adjuvant chemotherapy was administered in 6 (30.0%) patients and post-operative chemotherapy in 3 (15.0%). Three (15.0%) patients had a history of prior irradiation. AlloDerm was implanted at the time of expander placement in 24 reconstructions. In 5 reconstructions, AlloDerm was placed as an onlay graft following the exchange procedure. Minor complications occurred in 10.0% following AlloDerm implantation (2 patients: cellulitis, n=1; seroma, n=1). There was no difference in the incidence of complications with (10.0%) or without (5.0%) the use of AlloDerm (p=1.000). There were no major complications, reconstructive failures, nor delays to administration of adjuvant breast cancer therapies.
Conclusions: Implantable AlloDerm may be used following mastectomy to facilitate complete coverage of a tissue expander and define the inferior-lateral limits of the expander pocket. Following the exchange procedure, AlloDerm may augment soft tissue coverage thereby decreasing rippling and implant visibility. The use of AlloDerm does not appear to increase the rate of peri-operative complications following immediate, postmastectomy expander/implant breast reconstruction.