A Nationwide Analysis Evaluating the Safety of Using Acellular Dermal Matrix with Tissue Expander-Based Breast Reconstruction

Abstract

Background In March 2021, the United States Food and Drug Administration (FDA) safety communication cautioned against the use of acellular dermal matrix (ADM) products in breast reconstruction and reiterated that the FDA does not approve ADM use in breast surgery. This study aims to assess the safety of ADM use in breast reconstruction. Methods Women who underwent ADM and non-ADM assisted tissue expander (TE)-based breast reconstruction were identified using the National Surgical Quality Improvement Program database (2012–2019). Trends of ADM use over time, and 30-day outcomes of surgical site infection (SSI), dehiscence, and unplanned reoperation were assessed. Results Of the 49,049 TE-based breast reconstructive cases, 42.4% were ADM assisted and 57.6% non-ADM assisted. From 2012 to 2019, the use of ADM increased from 26.1 to 55.6% (relative risk [RR] =1.10; p < 0.01). Higher rates of SSI (3.9 vs. 3.4%; p = 0.003) and reoperation (7.4 vs. 6.0%; p < 0.001) were seen in the ADM cohort. There was no significant difference seen in dehiscence rates (0.7 vs. 0.7%; p = 0.73). The most common reoperation within 30 days for the ADM group (17.6%) was removal of TE without insertion of implant (current procedural terminology: 11,971). ADM-assisted breast reconstruction was associated with increased relative risk of SSI by 10% (RR = 1.10, confidence interval [CI]: 1.01–1.21; p = 0.03) and reoperation by 15% (RR = 1.15, CI: 1.08–1.23; p < 0.001). Conclusions ADM-assisted breast reconstruction more than doubled from 2012 to 2019. There are statistically higher complication rates of SSI (0.5%) and reoperation (1.4%) with ADM use in TE-based breast reconstruction, suggesting that reconstruction without ADM is safe when comparing immediate postoperative outcomes.

Application of dermal substitutes in the surgical treatment of full‐thickness wounds: Outcomes of an international survey

“…Additionally, they find application in addressing full‐thickness skin defects arising from various sources, including traumatic injuries, post‐melanoma surgical resections and breast reconstruction procedures. 28 , 29 , 30 …”

“…Additionally, they find application in addressing fullthickness skin defects arising from various sources, including traumatic injuries, post-melanoma surgical resections and breast reconstruction procedures. [28][29][30] A study by Bloemen et al showed improved scar parameters in 34 reconstructive wounds treated with Matriderm ® compared with split-thickness skin graft alone in a 12-year follow-up of 26 patients. 3 Moreover, the effectiveness of dermal substitution in acute burn wounds was shown in long-term scar elasticity when a dermal substitute was used in combination with topical negative pressure (TNP) therapy versus substitute alone (respectively 21 and 23 patients).…”

“…Dermal substitutes are mainly used in acute and reconstructive burn surgery, particularly for treating deep burns. Additionally, they find application in addressing full‐thickness skin defects arising from various sources, including traumatic injuries, post‐melanoma surgical resections and breast reconstruction procedures 28–30 …”