Background:Acellular dermal matrices (ADMs) provide clinical benefits in breast reconstruction but have been associated with increased postoperative complications, most frequently seromas. Fenestration of the ADM before insertion into the reconstructed breast may reduce the incidence of postoperative complications. In this retrospective analysis, postoperative complications were assessed after breast reconstruction with or without fenestrated ADMs.Methods:Patients who underwent immediate 2-staged implant breast reconstructions using ADM at a single center were assessed. The number of reconstructed breasts was stratified by ADM fenestration status and ADM type. The incidence of seroma, infection, extrusion, and explantation, and cosmetic score, was compared within the 2 stratified groups. A multivariable regression was performed to identify independent risk factors associated with these complications and aesthetic outcome.Results:In total, data from 450 patients who had 603 breast reconstructions using either AlloDerm or FlexHD demonstrated a significantly higher incidence of seroma with nonfenestrated ADMs (20%) versus fenestrated ADMs (11%; P = 0.0098). Rates of infection and explantation, and cosmetic score, were not influenced by fenestration status. In the multivariable analysis, ADM fenestration remained a significant protective factor for seroma formation. FlexHD also yielded a lower incidence of extrusion (P = 0.0031) and a higher cosmetic score (P = 0.0466) compared with AlloDerm after adjusting for other risk factors.Conclusions:The results of this study support ADM fenestration for reduction of seroma incidence in breast reconstruction, without affecting cosmetic results. Additionally, the choice of ADM may reduce extrusion incidence and improve aesthetic outcomes.

We conclude that prepalpable and preinvasive breast cancer can be detected in the PAM patient by mammography and that the stage of presentation in this group is not significantly different than in nonaugmented patients. Total mastectomy is preferred over breast-preserving procedures for the treatment of breast cancer in the PAM patient.

Introduction: Immediate breast reconstruction following mastectomy using human acellular dermal matrix (HADM) offers clinical benefits over reconstruction without HADM. However, guidance on HADM use, questions regarding complications, and lack of outcomes and comparison data remain. In this retrospective chart review, clinical outcomes following breast reconstruction with or without HADM and by HADM type are evaluated to address these issues. Materials and Methods: Charts for all patients undergoing breast reconstruction at a single clinic from 2006 to 2011 were collected. Information extracted included baseline patient demographics and disease characteristics, comorbidities, medications, type of HADM in breast reconstruction (FlexHD, AlloDerm, or no HADM), clinical outcomes, and esthetic results. Variables with significant group differences were risk-adjusted in multivariate analyses for postoperative and aesthetic outcomes. Results: A total of 650 patient charts (881 breast reconstructions) were analyzed, with few differences in patient/clinical characteristics between the HADM and no-HADM groups. The most commonly reported clinical complications in all groups were seroma and infections. The AlloDerm group had an increased adjusted risk of complications compared with the no HADM group; the FlexHD group had no significant differences compared with the no-HADM group. Both FlexHD and AlloDerm groups exhibited significantly higher perceived esthetic results compared with the no-HADM group (8.22 and 8.02 vs 6.53, respectively, P < .0001). Conclusions: These results suggest that the enhanced esthetic outcomes with HADM and expanders/implants in breast reconstruction may outweigh the risk of certain surgical complications, especially with FlexHD. Appropriate patient selection based on complication risk factors may further increase the benefit-to-risk ratio for HADM use in breast reconstructions.

False-positive diagnosis of lymph nodes occurs when a benign element in a lymph node, or in its capsule, is interpreted as metastatic carcinoma. This report describes a patient with breast carcinoma who had megakaryocytes in axillary sentinel lymph nodes mimicking metastatic carcinoma. The patient had no history of a hematologic disease, and we found no evidence of a concurrent hematopoietic disorder. The megakaryocytes were reactive for CD31, CD61, and von Willebrand factor, but not for cytokeratin (AE1/AE3). Megakaryocytes should be added to the list of benign histologic abnormalities that may simulate metastatic carcinoma in a sentinel lymph node.