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Acellular dermal matrix in tissue expander-based breast reconstruction predicts increased infection and seroma in a multivariate regression model .

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  1. Acellular dermal matrix in tissue expander-based breast reconstruction predicts increased infection and seroma in a multivariate regression model Eric D Wang BS, Steven T Lanier BA, BS, TayganYilmaz MPH, Brett T Phillips MD, Balvant P Arora MD, Steven M Katz MD, Sami U Khan MD, Alexander B Dagum MD, Duc T Bui, MD Stony Brook University Medical Center Division of Plastic and Reconstructive Surgery American Society of Plastic Surgeons: Plastic Surgery 2010 Toronto, ON

  2. Disclosures: nothing to disclose

  3. Breast reconstruction with tissue expanders • Acellular Dermal Matrix (ADM) is a relatively recent adjuncttoimplant-based breast reconstruction • Suggested benefits include: • Prevention of implant exposure • Improved control of the inframammary fold • Improved aesthetics, with a more natural ptosis • Improved expansion dynamics

  4. Reported complication rates with ADM * Denotes statistical significance ★ No statistical comparison was made

  5. Research question What are the complication risks associated with acellular dermal matrix use?

  6. Methods • Design: retrospective database review • Setting:postmastectomyTE/I breast reconstructions at a single center between 2004 and 2009 • Samplesize • ADM: 105 breasts (77 patients) • non-ADM: 161 breasts (105 patients) • Statistical analysis • Descriptive statistics, Student’s t-, and Fisher’s Exact • Multivariate logistic regression

  7. Model parameters: predictor variables • Age • BMI • Tobacco • Neoadjuvant chemotherapy and radiation • Postop chemotherapy and radiation • ADM use • Indication for mastectomy • Time between stages • JP drain duration • Mastectomy specimen weight • Tissue expander size • Intraoperative fill volume

  8. Modelparameters: outcome variables • Infection • Mastectomy skin necrosis • Seroma • Hematoma • Capsular contracture • Expander explantation due to infection • Reoperation due to complications

  9. Results: baseline patient characteristics * Denotes statistical significance

  10. Results:univariate analysis * Denotes statistical significance

  11. Results: multivariate regression model • Significant independent predictors of infection:

  12. Results: multivariate regression model • Significant independent predictors of seroma formation:

  13. Conclusions • Acellular dermal matrix is associated with increased risk of infection and seroma, independent of other factors influencing operative outcome • Proposed benefits of ADM must be weighed against the risk of increased complications

  14. Minimizing future complications • Understanding the etiology of complications • Refinement of surgical and postoperative care protocols to avoid complications with ADM • Utilizing risk factors to guide patient selection and preoperative planning for breast reconstruction

  15. References and Contact • Preminger BA, McCarthy CM, Hu QY, Mehrara BJ, Disa JJ. The influence of AlloDerm on expander dynamics and complications in the setting of immediate tissue expander/implant reconstruction: a matched-cohort study. Ann PlastSurg60; 510-513; 2008. • Chun YS, Verma K, Rosen H, Lipsitz S, Morris D, Kenney P, Eriksson E. Implant-based breast reconstruction using acellular dermal matrix and the risk of postoperative complications. PlastReconstrSurg125; 429-436; 2010. • Lanier ST, Wang ED, Chen JJ, Arora BP, Katz SM, Khan SU, Dagum AB, Bui DT. The effect of acellular dermal matrix use on complication rates in tissue expander/implant breast reconstruction. Ann PlastSurg64; 674-678; 2010. • Antony AK, McCarthy CM, Cordeiro PG, Mehrara BJ, Teo EH, Arriaga AF, Disa JJ. Acellular human dermis implantation in 153 immediate two-stage tissue expander breast reconstructions: determining the incidence and significant predictors of complications. PlastReconstrSurg125; 1606-1614; 2010. • Nahabedian MY. AlloDerm performance in the setting of prosthetic breast surgery, infection, and irradiation. PlastReconstrSurg 124: 1743; 2009. • Sbitany H, Sandeen SN, Amalfi AN, Davenport MS, Langstein HN. Acellular dermis-assisted prosthetic breast reconstruction vs complete submuscular coverage: a head-to-head comparison of outcomes. PlastReconstrSurg124: 1735, 2009. Contact: Duc T. Bui, MD Stony Brook University Medical Center Division of Plastic and Reconstructive Surgery HSC T19-060 Stony Brook, NY 11794

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