Abstract: Sterile “Ready to Use” Alloderm Decreases Posteropeative Infectious Complications in Patients Undergoing Immediate Implant Based Breast Reconstruction With Acellular Dermal Matrix (Plastic Surgery 2013)

Monday, October 14, 2013: 11:15 AM

Katie E. Weichman, MD , Plastic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY

Stelios C Wilson, BS , Plastic Surgery, New York University, New York, NY

Pierre B. Saadeh, MD , Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY

Alexes Hazen, MD , Institute of Reconstructive Plastic Surgery, NYU Langone Medical Center, New York, NY

Jamie P. Levine, MD , Institute of Reconstructive Plastic Surgery, New York University, New York, NY

Mihye Choi, MD , Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY

Nolan S Karp, MD , Institute of Reconstructive Plastic Surgery, New York Medical Center, New York, NY

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Background:

Acellular dermal matrix (ADM) has become a commonly used adjunct in immediate implant based breast reconstruction. However, several recent studies revealed increased perioperative complications associated with its use.^1-4 Recently, sterile “ready to use”(RTU) ADM was introduced and utilized as an alternative to the aseptic predecessor. The purpose of this investigation is to compare the infectious complications of breast undergoing reconstruction with aseptic ADM and RTU ADM.

Methods:

After obtaining IRB approval and instituting strict guidelines for ADM use, a review of all patients undergoing immediate implant based breast reconstruction at a single institution over a two-year period, November 2010-October 2012, was conducted. Alloderm (Life Cell. Branchburg, NJ) was used solely as source of ADM and RTU alloderm was introduced into use one year after initiating guidelines. Breasts were divided into three cohorts: submuscular coverage, aseptic ADM, and sterile ADM. Breast were analyzed in comparison based on demographics, cancer qualities, medical history, smoking history, tissue expander (TE) size, initial TE fill, percentage TE fill, and complications including mastectomy skin flap necrosis, infection and need for explantation.

Results:

546 breasts underwent immediate implant based breast reconstruction. 64.2% (n=351) had reconstruction without ADM, 16.4% (n=90) had reconstruction with aseptic ADM and 19.2% (n=105) had reconstruction with RTU ADM. When comparing breasts reconstructed with aseptic ADM to those with RTU ADM patients were similar in age, BMI, indication for surgery, TE size, fill, and percentage fill, medical comorbidities, and smoking status. However, patients undergoing reconstruction with RTU ADM were found to have a significant decrease in overall infection (8.5% versus 20.0% (p=0.0088)), major infection requiring IV antibiotics (4.7% versus 12.2% p=0.069), and need for explantation (1.9% versus 6.6% (p=0.1470) when compared to the aseptic cohort. When comparing patients undergoing reconstruction with RTU ADM to those having submuscular coverage patients had similar overall infectious complications at 8.5% versus 5.7% (p=0.3602) respectively. Diabetes mellitus, postoperative seroma, mastectomy skin flap necrosis, and reconstruction with aseptic ADM were found to be independent predictors of infectious complications.

Conclusion:

While not indicated for all patients, the use of RTU ADM in immediate implant based breast reconstruction provides an acceptable and useful adjunct. Additionally, RTU ADM mitigates the risks of infectious complications in patients undergoing immediate implant based breast reconstruction when compared to aseptic ADM.

22154 Sterile “Ready to Use” Alloderm Decreases Posteropeative Infectious Complications in Patients Undergoing Immediate Implant Based Breast Reconstruction With Acellular Dermal Matrix