Sunday, October 3, 2010
17646

Comparison of Immediate Implant-Based Reconstruction with and without Acellular Dermal Matrix

Andrew J. Vardanian, MD, John L. Clayton, MD, PhD, Jason Roostaeian, MD, Vaheh Shirvanian, MD, Andrew Da Lio, MD, Joan E. Lipa, MD, MSc, Christopher Crisera, MD, and Jaco H. Festekjian, MD. Department of Surgery, Division of Plastic and Reconstructive Surgery, UCLA Medical Center, 200 UCLA Medical Plaza, Suite 465, Los Angeles, CA 90095-6960

Purpose: Acellular dermal matrix (ADM) is frequently used in expander-based breast reconstruction to cover and support the inferior aspect of the breast pocket. The performance profile of ADM remains equivocal in expander-based breast reconstruction. Limited data exist on the final outcome of the inframammary fold (IMF) after reconstruction using ADM.

Methods: All patients undergoing expander-based immediate breast reconstruction from 2000-2008 at a single academic medical center were evaluated. Autologous flap reconstructions were excluded. Aesthetic outcomes were graded on a 4 point scale and based on an established scoring system. Direct comparisons were made between ADM and non-ADM cohorts to evaluate functional and cosmetic outcomes.

Results: A total of 203 patients underwent 337 immediate expander-based breast reconstructions [ADM group n=208 (61.7%) non-ADM group n=129 (38.3%)]. Patient characteristics including age at time of reconstruction (mean 49 ±11 vs. 47±10 years) and BMI (mean 23±5 vs. 23±3 kg/m2) were similar between groups (P>0.05). Complications occurred in one third of our patients (33.5%). In univariate analyses ADM use had lower overall complications (OR 0.61, 95% CI 0.38-0.97), less capsular contracture (OR 0.16, 95% CI 0.73-0.38), problems with the IMF (OR 0.370, 95% CI 0.19-0.71), bottoming out (OR 0.35, 95% CI 0.15-0.81), rippling (OR 0.32, 95% CI 0.13-0.80) and mechanical shifting of the implant (OR 0.19, 95% CI 0.06-0.60). Incidence of seroma/hematoma (P=0.59), infection (P=0.31), and wound complications (P=0.26) did not differ between groups. Aesthetic outcome ratings were higher in the ADM group. In multivariate logistic regression, after adjusting for clinical characteristics and post-operative complications, ADM use was associated with less capsular contracture (OR 0.18, 95% CI 0.08-0.43), mechanical shifting (OR 0.23, 95% CI 0.06-0.78), and less problems of the IMF (OR 0.49, 95% CI 0.23-1.01).

Summary: This is the largest direct comparison of ADM in expander-based immediate breast reconstruction without the use of autologous flaps.

Conclusion: Optimizing the IMF with ADM creates a superior aesthetic result. ADM use appears safe and is associated with less capsular contracture, mechanical shift, and problems with the IMF without increase in post-operative complications. We continue to endorse the usefuleness of ADM in immediate expander-based breast reconstruction.

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