Abstract: Comparison of Immediate Implant-Based Reconstruction with and without Acellular Dermal Matrix (Plastic Surgery 2010 (October 1-5, 2010))

Sunday, October 3, 2010: 9:35 AM

Metro Toronto Convention Centre

Andrew J. Vardanian, MD , Department of Surgery, Division of Plastic and Reconstructive Surgery, UCLA Medical Center, Los Angeles, CA

John L. Clayton, MD, PhD , Department of Surgery, Division of Plastic and Reconstructive Surgery, UCLA Medical Center, Los Angeles, CA

Jason Roostaeian, MD , Department of Surgery, Division of Plastic and Reconstructive Surgery, UCLA Medical Center, Los Angeles, CA

Vaheh Shirvanian, MD , Department of Surgery, Division of Plastic and Reconstructive Surgery, UCLA Medical Center, Los Angeles, CA

Andrew Da Lio, MD , Department of Surgery, Division of Plastic and Reconstructive Surgery, UCLA Medical Center, Los Angeles, CA

Joan E. Lipa, MD, MSc , Department of Surgery, Division of Plastic and Reconstructive Surgery, UCLA Medical Center, Los Angeles, CA

Christopher Crisera, MD , Department of Surgery, Division of Plastic and Reconstructive Surgery, UCLA Medical Center, Los Angeles, CA

Jaco H. Festekjian, MD , Department of Surgery, Division of Plastic and Reconstructive Surgery, UCLA Medical Center, Los Angeles, CA

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 ą11 vs. 47ą10 years) and BMI (mean 23ą5 vs. 23ą3 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.

17646 Comparison of Immediate Implant-Based Reconstruction with and without Acellular Dermal Matrix