Purpose:

Acellular dermal matrix (ADM) is a popular adjunct to two-stage tissue expander/implant (TE/I) breast reconstruction following mastectomy. Touted benefits include the ability to rapidly expand the breast mound and improved aesthetic results. Recent comparative studies have raised the possibility of higher complication rates associated with ADM use. However, many studies are limited due to sample size and inability to account for existing predisposing patient conditions. Our study assessed relative risks for complications in a large series of TE/I breast reconstructions using a robust multivariate regression model.

Methods and Materials:

Design: Retrospective review of 266 consecutive TE/I breast reconstructions in 186 patients performed at a single institution from 2005 to 2009.

Statistical Analysis: Student's t- and Fisher's exact tests, multivariate logistic regression modeling.

Model Parameters: Age, body mass index (BMI), tobacco use, pre- and post-operative chemotherapy and radiation, indication for mastectomy (therapeutic or prophylactic), ADM use, complications (infection, seroma, skin necrosis, hematoma, reoperation, explantation, capsular contracture), fill parameters (TE size, initial fill volume, total fill volume, ratio of initial fill volume to TE size, time between expander placement and exchange for permanent implant), mastectomy specimen weight, and JP drainage duration.

Results:

When controlling for all model parameters, reconstructions with ADM had more than 12 times greater odds of developing an infection (OR =12.86, P = 0.04, 95% CI 1.07 – 155.0) and more than 7 times greater odds of developing a seroma (OR = 7.38, P = 0.008, 95% CI 1.7 – 32.02) compared to those not utilizing ADM. The model also identified preoperative radiation as an independent predictor of infection (OR = 312.3, P= 0.04, 95% CI 1.33-73273). As would be expected, younger age was associated with decreased odds of postoperative infection. (OR = 0.86 P=0.02, 95% CI 0.76-0.98).

Conclusions:

When controlling for various demographic and perioperative variables, reconstructions employing ADM showed a statistically significant greater odds of infection and seroma, despite previous studies demonstrating superior expansion characteristics.