No Differences in Surgical and Patient-reported Outcomes Between Alloderm, Surgimend, and Dermacell for Prepectoral Implant-based Breast Reconstruction

Abstract

Background: Prepectoral implant–based breast reconstruction (IBR) has become the standard of care for many reconstructive surgeons and is often supplemented with coverage using acellular dermal matrix (ADM). However, more clinical data examining the use of ADM in breast reconstruction are needed. The current study compares complications and patient-reported outcomes (PROs) among three different types of ADM used in IBR. Methods: The authors performed a retrospective review of consecutive patients who underwent immediate prepectoral IBR from January of 2018 through December of 2019. Surgical outcomes and PROs (using the BREAST-Q) were compared among the AlloDerm, SurgiMend, and Dermacell ADMs. Results: Overall, 557 breasts (383 patients) were included (78.6% AlloDerm, 14% SurgiMend, 7.4% Dermacell). Patients in the Dermacell group were older (P = 0.001) and more likely to have diabetes (P = 0.001) compared with AlloDerm and SurgiMend patients. Other patient characteristics were similar among the three groups. The overall complication rate was equivalent among the three ADM groups (AlloDerm 27% vs SurgiMend 33% vs Dermacell 39%; P = 0.209). Multivariable frailty models demonstrated that the type of ADM was not significantly associated with overall complications, infection, major complications, or device explantation. BREAST-Q satisfaction with breasts, psychosocial well-being, and sexual well-being were also similar among the three ADM groups (P = 0.109, P = 0.439, P = 0.152, respectively). Conclusions: Three of the most commonly used ADMs in the United States have similar surgical outcomes and PROs when used for prepectoral IBR. No significant differences in infection, overall complications, or device removal rates were identified among AlloDerm, SurgiMend, and Dermacell. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

The Spectrum of Non-neoplastic Changes Associated With Breast Implants

“…100,104 ACELLULAR DERMAL MATRIX COMPLICATIONS Definition Acellular grafts are used to improve implant positioning and support for implant-based reconstruction, with the expectation of fewer complications and failure rates. 105,106 The most commonly used are derived from FIGURE 8. Granulomatous inflammation.…”

“…105 The FDA released a safety communication concerning complications, including infection in 2021. 105…”

“…Acellular grafts are used to improve implant positioning and support for implant-based reconstruction, with the expectation of fewer complications and failure rates 105,106 . The most commonly used are derived from cadaveric humans, such as AlloDerm (Allergan) and FlexHD (Musculoskeletal Foundation Biologics); less often used are grafts derived from porcine (Strattice) and bovine (Surgimend) dermal tissue that are processed with different protocols to eliminate cellular and immunogenic components.…”

“…The most commonly used are derived from cadaveric humans, such as AlloDerm (Allergan) and FlexHD (Musculoskeletal Foundation Biologics); less often used are grafts derived from porcine (Strattice) and bovine (Surgimend) dermal tissue that are processed with different protocols to eliminate cellular and immunogenic components. These products are widely utilized in breast reconstruction but are still considered off-label by the US FDA 105 . The FDA released a safety communication concerning complications, including infection in 2021 105 …”

“…These products are widely utilized in breast reconstruction but are still considered off-label by the US FDA 105 . The FDA released a safety communication concerning complications, including infection in 2021 105 …”