Purpose:  Since 2006, an increasing number of studies have discussed the use of Acellular Dermal Matrix (ADM) in prosthetic breast reconstruction.  It remains unknown how ADM-assisted breast reconstructions behave in the setting of radiation.  The purpose of this study was to compare outcomes following two-stage, Alloderm-assisted prosthetic breast in the setting and absence of radiotherapy.        

Methods:  The authors performed a retrospective review of all patients who underwent Alloderm-assisted, two-stage prosthetic breast reconstruction at a single institution from 2003 to 2009.  Charts were evaluated for patient demographics, neoadjuvant and adjuvant radiotherapy, and stage 1 and 2 postoperative outcomes.  Student's t test was used for comparison of continuous variables and Fisher's exact test for evaluation of percentages or frequencies.  A p value less than 0.05 was considered statistically significant.

Results:  231 patients underwent two-stage, Alloderm-assisted prosthetic breast reconstruction.  Mean patient age was 46.9 years.  Average overall follow-up was 16.1 months, with a mean follow-up time since stage 2 of 11.4 months.  Demographics were similar between patients with nonirradiated and irradiated breasts.  336 breasts underwent stage 1 reconstruction.  Comparison of outcomes (Table I) revealed a significantly higher rate of capsular contracture in the setting of radiotherapy but statistically similar rates of infection, hematoma, seroma, flap necrosis, and explantation due to infection.  283 breasts underwent stage 2 reconstruction.  Comparison of outcomes (Table II) demonstrated significantly higher rates of infection and capsular contracture in the setting of radiotherapy but statistically similar rates of explantation and revision.

Conclusions:  Based upon this large-volume experience of two-stage, Alloderm-assisted prosthetic breast reconstructions, rates of capsular contracture were significantly higher in the setting of radiotherapy.  Infection was significantly higher in the setting of radiotherapy following stage 2 reconstruction.  Rates of flap necrosis, seroma, explantation due to infection, and revision were statistically similar in the presence or absence of radiotherapy.  These findings highlight the potential benefit of ADM for prosthetic breast reconstruction in the setting of radiotherapy. 

TABLE I. STAGE 1 OUTCOMES IN ABSENCE/PRESENCE OF RADIOTHERAPY
	NO XRT (N = 282)		XRT (N = 54)
	Number	%	Number	%	p value
Complications
Infection	20 / 282	7.1	6 / 54	11.1	0.28
Hematoma	3 / 282	1.1	0 / 54	0.0	1.00
Seroma	12 / 282	4.3	5 / 54	9.3	0.17
Flap necrosis	14 / 282	5.0	4 / 54	7.4	0.51
Explantation due to infection	9 / 282	3.2	1 / 54	1.9	1.0
Capsular Contracture	2 / 282	0.7	16 / 54	29.6	<0.0001

TABLE II. STAGE 2 OUTCOMES IN ABSENCE/PRESENCE OF RADIOTHERAPY
	NO XRT (N = 244)		XRT (N = 39)
	Number	%	Number	%	p value
Complications
Infection	2 / 244	0.8	3 / 39	7.7	0.02
Explantation due to infection	2 / 244	0.8	2 / 39	5.1	0.09
Capsular Contracture	5 / 244	2.0	6 / 39	15.4	0.001
Revision	58 / 244	23.8	10 / 39	25.6	0.840