Purpose: AlloDerm is used in the breast reconstruction to provide internal support of the implant. The dermal matrix sling is anchored to the pectoralis major and the inframammary crease. Although, AlloDerm is free of cellular components responsible for the antigenic response, its processing does not guarantee sterility. We examined the infectious complications in breast reconstructions with and without AlloDerm.
Methods: A chart review was done on 321 expander/implant breast reconstructions from 1998-2008. Seventy-four reconstructions used AlloDerm and 247 reconstructions did not. Primary outcomes of the study are the incidence of readmission for IV antibiotics and explantation. Prosthetic explantations due to hematoma or patient dissatisfaction were excluded. Late complications were also examined.
Results: There was no difference in the rates of readmission but explantation rates due to infected fluid collections and extrusion was higher in the AlloDerm group (6.8%) vs. control group (2.0%), which was statistically significant (p=0.04). No other outcome was statistically significant.
Conclusion: Although the rates of readmission for IV antibiotics for cellulitis did not differ, the rate of explantation was statistically higher in reconstructions using AlloDerm. This technique has great potential, especially for single-staged implant-based reconstruction; however, counseling of patients about the higher risk of explantation is necessary.
Table 1. Infection Rates
| No Alloderm | Alloderm | Total |
| ||||
Expander/ Implant | Implant | Total | Expander/ Implant + Alloderm | Implant + Alloderm | Total |
| P | |
N – no. cases | 198 | 49 | 247 | 25 | 49 | 74 | 321 |
|
Readmission for IV Antibiotics – no. (%) | 6 | 1 | 7 | 1 | 1 | 2 | 9 | 0.965f |
3.0% | 2.0% | 2.8% | 4.0% | 2.0% | 2.7% | 2.8% |
| |
Explant due to infection, seroma, extrusion – no. (%) | 5 | 0 | 5 | 1 | 4 | 5 | 10 | 0.040c |
2.5%
| 0% | 2.0 % | 4.0%
| 8.2% | 6.8% | 3.1% |
| |
f Fisher's Exact Test
c Chi squared Test
Table 2: Secondary Complications according to Alloderm usage
| No Alloderm N= 247 | Alloderm N = 74 | Total N = 321 | P |
Capsular Contraction | 17 | 9 | 26 | .144c |
| 6.9% | 12.2% | 8.1% |
|
Implant Rupture | 1 | 0 | 1 | .584f |
| .4% | .0% | .3% |
|
Implant Deflation | 4 | 1 | 5 | .870f |
| 1.6% | 1.4% | 1.6% |
|
Implant Malposition | 21 | 7 | 28 | .798c |
| 8.5% | 9.5% | 8.7% |
|
Implant Rippling | 6 | 3 | 9 | .458f |
| 2.4% | 4.1% | 2.8% |
|
Mastectomy Skin Loss | 7 | 4 | 11 | .286f |
| 2.8% | 5.4% | 3.4% |
|
c Chi squared Test
f Fisher's Exact Test