A Cohort Analysis of Early Outcomes After AlloDerm, FlexHD, and SurgiMend Use in Two-Stage Prepectoral Breast Reconstruction

Abstract

Background Acellular dermal matrix (ADM) is frequently used in prepectoral breast reconstruction, but few studies have examined the role of ADM type on complication risk. Objectives This study determines the impact of ADM type on early complication rates in prepectoral two-stage alloplastic breast reconstruction. Methods We performed a cohort examination of all patients who underwent mastectomy with immediate prepectoral two-stage alloplastic breast reconstruction with ADM support at Memorial Sloan Kettering Cancer Center from 2018-2021. ADM types utilized included Alloderm (Allergan, Madison, NJ), FlexHD (Musculoskeletal Transplant Foundation, Edison, NJ), or SurgiMend (TIE Biosciences, Inc., Boston, MA). Complication rates based on number of tissue expanders (TEs) were determined for each ADM type. Multivariate logistic regression was used to determine the impact of ADM type on complication risk after accounting for confounders. Results Overall, 726 patients (1054 TEs: 194 Alloderm, 93 FlexHD, 767 SurgiMend) were included. The three cohorts differed in terms of mastectomy type (Nipple-sparing: 23.5% of Alloderm, 33.3% of FlexHD, 19.1% of SurgiMend, p = 0.047), ADM perforation (Perforated: 94.8% of Alloderm, 98.2% of FlexHD, 100% of SurgiMend, p < 0.001), and ADM size (Alloderm: 132cm2 [IQR: 132-164], FlexHD: 220cm2 [IQR: 220220], SurgiMend: 200cm2 [IQR: 200-200], p < 0.001). On univariate examination, no differences existed between ADM types for seroma, infection, exposure, malposition, or TE loss. Additionally, after adjustment for confounders with multivariate regression, no ADM type had higher odds of TE loss. Conclusions In this large cohort of prepectoral reconstruction patients, ADM type did not significantly affect risk of complications. Additional prospective studies are warranted to evaluate ADM choice for prepectoral breast reconstruction in a head-to-head fashion.