Does Acellular Dermal Matrix Thickness Affect Complication Rate in Tissue Expander Based Breast Reconstruction?

Abstract

Background. While the benefits of using acellular dermal matrices (ADMs) in breast reconstruction are well described, their use has been associated with additional complications. The purpose of this study was to determine if ADM thickness affects complications in breast reconstruction. Methods. A retrospective chart review was performed including all tissue expander based breast reconstructions with AlloDerm (LifeCell, Branchburg, NJ) over 4 years. We evaluated preoperative characteristics and assessed postoperative complications including seroma, hematoma, infection, skin necrosis, and need for reintervention. We reviewed ADM thickness and time to Jackson-Pratt (JP) drain removal. Results. Fifty-five patients underwent 77 ADM-associated tissue expander based breast reconstructions, with average age of 48.1 years and average BMI of 25.9. Average ADM thickness was 1.21 mm. We found higher complication rates in the thick ADM group. Significant associations were found between smokers and skin necrosis (p < 0.0001) and seroma and prolonged JP drainage (p = 0.0004); radiated reconstructed breasts were more likely to suffer infections (p = 0.0085), and elevated BMI is a significant predictor for increased infection rate (p = 0.0037). Conclusion. We found a trend toward increased complication rates with thicker ADMs. In the future, larger prospective studies evaluating thickness may provide more information.

Lessons Learned from Three Different Acellular Dermal Matrices in Direct-to-Implant Breast Reconstruction

“…While some authors advocate the use of ADM and propose a better perfusion of the skin flap after mastectomy [16], several authors remark that the ADM needs profound perfusion for integration. This might not be the case in critically per- (thickness > 1.2 mm) ADM are used [22]. As the thickness of the ADM increases, perfusion and ingrowth of repopulating cells gets more difficult and renders these ADM more prone to failure of integration.…”

Non-integrated acellular dermal matrix in breast reconstruction: a case report

“…Common complications to the use of ADM include infection, wound dehiscence, necrosis, seroma, haematoma, capsular contracture, extrusion, loss of implant and reconstruction failure. Thick ADMs appear to have an overall higher rate of complications compared to thinner ADMs [ 11 ].…”

“…The pliable version of Strattice is recommended for breast reconstruction. Compared to other ADMs, Strattice appears to be integrated slower, perhaps due to its greater thickness [ 11 ]. A large-animal study [ 12 ] found in that ADMs typically obtain early angiogenesis at 4 weeks after implantation and flow at 12 weeks after implantation.…”

Simple-safe-sure Fluid Drainage Just above Breast Tissue Expander using 18-Gauge Blunt Cannula

“…Seroma is a relatively frequent postoperative complication that is associated with breast tissue expander (TE) insertion. A small amount of seroma is usually spontaneously absorbed by the surrounding tissue; however, the prolonged presence of seroma can cause infection and purulency 1 , 2 ; thus, the removal of the TE cannot be avoided in some cases. For this reason, obvious fluid collection around a TE should be drained as soon as possible.…”