Outcomes of Acellular Dermal Matrix for Immediate Tissue Expander Reconstruction with Radiotherapy

Despite increasing literature support for the use of acellular dermal matrix (ADM) in expander based breast reconstruction, its effect on clinical outcomes in the presence of radiation therapy (RT) has not been well described.^1-6

A retrospective review of a prospectively maintained database was performed who underwent immediate tissue expander (ITE) breast reconstruction from 2004 to present at the M.D. Anderson Cancer Center. There were four cohorts: total muscle coverage (TMC), TMC with radiation therapy (RT), ADM, and ADM with RT. Primary outcomes: re-operation requiring expander exchange or loss, seroma, infection, delayed wound healing. Univariate and multivariate regression models were used to analyze for potential confounding variables.

1379 patients underwent ITE reconstruction. 707 patients had TMC, 107 TMC with RT, 485 ADM, and 80 ADM with RT. Overall complication rate between ADM and TMC cohorts were 31.68% and 14.50% respectively (p <0.001). Infections occurred more frequently within the ADM cohort (15 % vs. 3.74%, p = 0.006). Incidence of seroma tended to be higher in the ADM cohort and highest within patients that did not receive RT (10.31 % vs. 3.53%, p >0.001). Incidences of explantation were too few to show statistical significance.

While overall complication rate, as well as incidence of infection and seroma appears to be higher in the patients undergoing ITE with ADM and RT; if recognized and appropriately treated the expander reconstruction is often salvaged.