Abstract: Positive Impact of Meshing Autogenous Dermal Matrix (ADM) on Pain, Length of Stay and Length of Time Required for Post-Operative Drains in Tissue Expander Based Breast Reconstruction (Plastic Surgery 2015)

Sunday, October 18, 2015: 1:30 PM

Sarah E Hagarty, BSc, MD, FRCSC , Department of Surgery, Division of Plastic Surgery, University of Illinois College of Medicine at Rockford, Rockford, IL

Lawrence Yen, B.S. , University of Illinois College of Medicine at Rockford, Rockford, IL

Christopher Fosco, MD , university of Illinois College of Medicine at Rockford, rockford, IL

Manorama Khare, PhD , Center for research on Women and Gender, University of Illinois College of Medicine at Rockford, Rockford, IL

Presentation PDF file

Purpose: To assess the impact of meshing autogenous dermal matrix (ADM) on outcomes in tissue expander breast reconstruction.

Methods : Thin RTU Alloderm^® was meshed through either a Brennan^® {1:1} or Zimmer^®{1.5:1} skin graft mesher for expander based breast reconstruction in a single surgeon community practice over 2 years. This cohort was compared to the previous cohort of the same surgeon's practise of unmeshed ADM for 7 years prior . Drain times and complication rates were compared between meshed (M-ADM) versus unmeshed ADM (UM-ADM). T-test and Levine's test for equality of variances were employed.

Materials: Length of time for drain removal (<30 cc per day) , complications, and outcomes were analyzed from 36 M-ADM and 116 UM-ADM breasts, 19 and 84 patients respectively. The relationship between drain time and type of ADM, (M or UM), was analyzed, controlling for variables: diabetes, hypertension, smoking status¹, BMI⁴, tissue expander/implant size¹, radiation treatment, and general surgeon. Minor and major complication rates were also assessed and compared. Range of follow up in the M-ADM group was 2 years, in the UM-ADM group 8 years.

Summary: In bivariate analysis, there was a significant statistical difference between time to drain removal in the two groups (p< 0.01). Mean time for drain removal was 18(+/-5) days in M-ADM versus 29(+/- 19) days in UM-ADM. There was no significant difference in mean age or BMI in the two groups.

Conclusions: Increased seroma formation when ADM is used in tissue expander based breast reconstruction has been raised as a possible negative outcome^1,2,3. We present a novel, easily reproducible approach to facilitate more rapid adherence and possibly healing of the ADM to the skin flap, analagous to the impact of meshing on healing in skin grafts, potentially limiting post-operative drainage. We have shown drain times were reduced with statistical significance in the meshed versus unmeshed ADM patients, without a significant difference in complication rates , {barring mesh ratios of 1.5:1 (but not 1:1) in previously irradiated patients}. To our knowledge, this is the first study to examine the relationship between post-operative drain time and complication rates of patients receiving meshed ADM in breast reconstruction. Our study highlights implications in improving surgical outcomes, through an easily reproducible, affordable technical variation of the use of ADM in expander based breast reconstruction.

27451 Positive Impact of Meshing Autogenous Dermal Matrix (ADM) on Pain, Length of Stay and Length of Time Required for Post-Operative Drains in Tissue Expander Based Breast Reconstruction