Total Muscle Coverage versus AlloDerm Human Dermal Matrix for Implant-Based Breast Reconstruction

Abstract

Background: Prosthetic breast reconstruction is the most common method for treatment of patients undergoing mastectomy. Acellular dermal matrix has become more popular in implant-based breast reconstruction. Methods: The authors conducted a retrospective review of all patients undergoing prosthetic breast reconstruction between August of 2002 and December of 2013. Patients were analyzed in terms of demographics, fill volumes, number of expansions, costs, and complications. Results: A total of 284 patients underwent mastectomy surgery with 481 implant-based breast reconstructions. Four hundred eight tissue expanders had total muscle coverage, whereas 73 had AlloDerm. The rate of overall complications and major complications was significantly higher in the AlloDerm group: 20.5 percent versus 8.8 percent (p = 0.005), and 13.7 percent versus 5.1 percent (p = 0.0001), respectively. The mean initial fill volume was significantly lower in the total muscle coverage group compared to the acellular dermal matrix group (54 ± 47 versus 167 ± 139; p = 0.00003), resulting in a higher number of expansions (8.1 versus 5.8; p = 0.000051) and longer time to full expansion (60.2 days versus 43.3 days; p = 0.0002). This did not translate into a faster time to expander exchange (162.4 days versus 162.3 days; p = 0.13). Use of AlloDerm added a mean cost of $2217 for each breast. Conclusions: Implant-based breast reconstruction has evolved with the advent of acellular dermal matrices. Although the use of acellular dermal matrix allows increased initial fill volumes and fewer total expansions, there is an increased risk of complications and increased costs, especially in patients undergoing bilateral reconstruction. Total muscle coverage remains an excellent option for providing quality breast reconstruction without increased complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Improving plastic surgery resident education and quality of care with outcomes feedback using the surgery report card: An initial experience

“…The initial PubMed/MEDLINE search revealed 46 articles eligible for full-text review; of these, 12 were included in both the systematic review and meta-analysis. [11][12][13][14][15][16][17][18][19][20][21][22] Among these 12 studies, nine were retrospective chart reviews, two were prospective cohort studies, and one was a randomized trial ( Figure 1 ).…”

“Direct-to-Implant, Prepectroal Breast Reconstruction: Geometric Breast Measurements and Changes at 2-Years of Follow-Up”

“…For preservation of the IMF, it has been previously demonstrated in dual-plane reconstruction that less implant displacement occurs with ADM use; however, this difference was not statistically significant. 8,13 Pocket-defining sutures may play a similar role in this regard; however, there currently exists no evidence-based comparison between suture pocket-plasty and dermal substitutes for pocket contour. In the present cohort, ADM was used in 79% of patients, but was only wrapped anteriorly around implants and thus not truly used in a structural context for pocket control.…”

From Salvage to Prevention: A Single-Surgeon Experience with Acellular Dermal Matrix and Infection in Prepectoral Breast Reconstruction

“…In conjunction with the change in drain protocol, the switch of acellular dermal matrix from AlloDerm (sterility assurance level, 10 −3 ) to DermACELL (sterility assurance level, 10 −6 ) may have played a role in the reduction in the rate of infection. The use of acellular dermal matrix in breast reconstruction has been associated with higher rates of seroma and infection in some studies [26][27][28][29][30][31][32][33][34] ; however, others have found equivalent complication rates with and without the use of acellular dermal matrix. [35][36][37][38][39][40][41][42] Industry funding of research involving acellular dermal matrix in breast reconstruction may compromise reliability of results, and as in all of medicine, negative findings may be underpublished, biasing the available literature.…”