by Powers, Jeremy M.; Reuter Muñoz, Katherine D.; Parkerson,
Jamie; Nigro, Lauren C.; Blanchet, Nadia P.
Plastic and Reconstructive Surgery: December 2021
- Volume 148 - Issue 6 - p 1201-1208
Background:
Increasing amounts of acellular dermal matrix are being used
with the adoption of prepectoral breast reconstruction. Postoperative infection
remains a challenge in breast reconstruction, and the contribution of acellular
dermal matrix type, processing, and sterility assurance level to risk of
complications in prepectoral reconstruction is not well studied.
Methods:
The authors performed a retrospective review of patients who
underwent immediate prepectoral breast reconstruction from February of 2017 to
July of 2020. Because of an increase in the rate of infection, the drain
protocol was changed and acellular dermal matrix type was switched from
AlloDerm (sterility assurance level, 10−3) to DermACELL (sterility assurance
level, 10−6) in January of 2019. Demographic and surgical variables were
collected, in addition to details regarding development and management of infection.
Results:
Despite higher rates of direct-to-implant reconstruction and
bilateral procedures and increased implant volumes, the rate of infection was
significantly lower in patients who received DermACELL instead of AlloDerm [two
of 38 (5.3 percent) versus 11 of 41 (26.8 percent); p = 0.014]. Drain
duration was slightly longer in the DermACELL group, consistent with the change
in drain protocol. Baseline demographic and clinical characteristics remained
similar between the two groups.
Conclusions:
With increased reliance on large amounts of acellular dermal
matrix for prepectoral breast reconstruction, it directly follows that the
properties of acellular dermal matrix with respect to incorporation, sterility,
and implant support are that much more important to consider. There have been
few studies comparing different types of acellular dermal matrix in prepectoral
breast reconstruction, and further research is required to determine the
contribution of acellular dermal matrix type and processing techniques to
development of postoperative infection.
