by Ivey, J. Simon;
Abdollahi, Hamid; Herrera, Fernando A.; Chang, Eric I
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.
