by Patel, Ashraf A.; Kayaleh, Hana; Sala, Luke A.; Peterson,
Dylan J.; Upadhyaya, Prashant K
Plastic and Reconstructive Surgery: September
2021 - Volume 148 - Issue 3 - p 511-521
Background: Aesthetic results in breast reconstruction for
ptotic/obese breasts may be improved when using Wise-pattern closures compared
with nipple-sparing mastectomies. In two-stage reconstruction, acellular dermal
matrix is commonly used to support the prosthesis. This study tests the
efficacy of an alternate technique that uses deepithelialized excess breast
skin in lieu of acellular dermal matrix. To better understand whether acellular
dermal matrix is necessary, the authors compared postoperative outcomes from
reduction-reconstructions that used matrix to those that did not.
Methods: The authors retrospectively reviewed the outcomes
of patients who underwent staged breast reconstruction following Wise-pattern
closures between September of 2016 and October of 2019. Two cohorts were
created based on whether acellular dermal matrix was used. Charts were reviewed
for incidence of postoperative complications.
Results: A total of 164 breasts were reconstructed in 85
female patients. The acellular dermal matrix cohort consisted of 68 breasts,
whereas the non–acellular dermal matrix cohort included 96 breasts. After the
first stage, the incidence of one or more complications was similar between
cohorts (acellular dermal matrix, 32.4 percent; nonmatrix, 35.4 percent; p =
0.684). Minor infection rates were significantly higher in reconstructions
using acellular dermal matrix (16.2 percent versus 6.3 percent; p = 0.040).
After the second stage, the complication incidence was also similar between
cohorts (acellular dermal matrix, 16.2 percent; nonmatrix, 13.5 percent; p =
0.638). Final follow-up time was 445.2 days.
Conclusions: Overall complication rates following both
stages of reconstruction were similar with and without acellular dermal matrix.
When acellular dermal matrix was used, minor infection rates were higher
following expander placement. In patients desiring a reduction-reconstruction,
the authors find the deepithelialized dermal flap provides ample prosthesis
support, without the need for acellular dermal matrix. CLINICAL QUESTION/LEVEL
OF EVIDENCE: Therapeutic, III.
