Decreased Length of Postoperative Drain Use, Parenteral Opioids, Length of Stay, and Complication Rates in Patients Receiving Meshed versus Unmeshed Acellular Dermal Matrix in 194 Submuscular Tissue Expander–Based Breast Reconstructions: A Single-Surgeon Cohort Study

Abstract

Background: Studies have cited possible complications and increased fluid accumulation in implant-based breast reconstruction using acellular dermal matrix. The authors propose a novel approach, manually meshing acellular dermal matrix using a skin graft mesher before use in expander-based breast reconstruction. The authors investigated postoperative drain time, complication rates, pain, and length of hospital stay in meshed versus unmeshed acellular dermal matrix cohorts. Methods: One hundred fourteen patients and 194 reconstructed breasts were included overall. Of these, 99 patients were included in the pain and postoperative length of hospital stay analysis. Independent t test and chi-square analyses were used for bivariate comparisons. Multiple linear regression analyses were used to further delineate impact of meshing acellular dermal matrix on drain time, postoperative parenteral narcotic requirements, and length of stay between the two cohorts. Results: The meshed acellular dermal matrix cohort had lower overall complication rates compared with the unmeshed cohort. Multiple linear regression analyses showed meshing the acellular dermal matrix alone decreased drain time by 7.3 days, and decreased postoperative parenteral narcotic requirements by 77 percent (20 mg morphine). Furthermore, it was the only significant predictor for a decrease in length of stay. Conclusions: Meshing acellular dermal matrix significantly decreased the time needed for postoperative drains. Statistical analysis showed significantly decreased overall and minor complication rates in the meshed cohort. Meshing significantly decreased parenteral narcotic requirements and, importantly, also decreased length of stay. All of these factors have important implications regarding cost and quality of care in expander-based breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

The relationship of human acellular dermal matrix thickness on complication rate and patient-reported outcomes in implant-based immediate breast reconstruction

“…Within the implanted thick ADM, there may be a relatively a longer process, involving the ingrowth of blood vessels and recolonization by fibroblasts, myofibroblasts, and various connective tissue free cells (lymphocytes, macrophages, granulocytes, mast cells). In addition, it has been suggested that porous ADMs provide a larger surface area of ADM/host interface, thus accelerating the integration process, and meshed ADM significantly decreased the time needed for postoperative drain (22,23). Nonetheless, in this study, ADM thickness did not affect the incidence of complications.…”

Usefulness of meshed SurgiMend in direct-to-implant breast reconstruction

“…Hagarty et al [25] reported that the use of meshed ADM in 192 cases in breast reconstructions involving a tissue expander was advantageous in terms of postoperative drain duration, hospitalization period, complications such as seroma, and frequency of painkiller use. In this study, the seroma rate was lower in patients who underwent DTI breast reconstruction using meshed SurgiMend than in those who underwent surgery using fenestrated SurgiMend, but the difference was not statistically significant.…”

Overview of Risk Factors and Prevention of Capsular Contracture Following Implant-Based Breast Reconstruction and Cosmetic Surgery: A Systematic Review

“…ADM is a popular intervention to reduce the rate of CC. An RCT has found that ADM does not reduce postoperative pain [43], but another study states that meshed ADM has significantly reduced overall complications including postoperative pain [36]. Multiple studies mention the promising outcomes of ADM in the incidence of CC; however, most of these studies were short of duration.…”

“…Due to the early formation of peri-implant fibrosis, ADM may play an important role in preventing the CC formation rather than delaying the formation [ 34 ]. In terms of the difference between the matrices, fenestrated acellular matrices are not significantly different than nonfenestrated matrices in the reduction of CC rates [ 35 ]; however, meshed acellular matrices significantly decrease the rates of minor complications including postoperative drain duration, narcotic use, and length of stay vs. unmeshed matrices [ 36 ].…”