Arch Plast Surg.  2013 Jan;40(1):19-27. 10.5999/aps.2013.40.1.19.

Human Acellular Dermis versus Submuscular Tissue Expander Breast Reconstruction: A Multivariate Analysis of Short-Term Complications

• Davila AA
• Seth AK
• Wang E
• Hanwright
• Bilimoria
• Fine N
• Kim JY

• KMID: 1432627
• DOI: http://doi.org/10.5999/aps.2013.40.1.19

Abstract

BACKGROUND
Acellular dermal matrix (ADM) allografts and their putative benefits have been increasingly described in prosthesis based breast reconstruction. There have been a myriad of analyses outlining ADM complication profiles, but few large-scale, multi-institutional studies exploring these outcomes. In this study, complication rates of acellular dermis-assisted tissue expander breast reconstruction were compared with traditional submuscular methods by evaluation of the American College of Surgeon's National Surgical Quality Improvement Program (NSQIP) registry.
METHODS
Patients who underwent immediate tissue expander breast reconstruction from 2006-2010 were identified using surgical procedure codes. Two hundred forty tracked variables from over 250 participating sites were extracted for patients undergoing acellular dermis-assisted versus submuscular tissue expander reconstruction. Thirty-day postoperative outcomes and captured risk factors for complications were compared between the two groups.
RESULTS
A total of 9,159 patients underwent tissue expander breast reconstruction; 1,717 using acellular dermis and 7,442 with submuscular expander placement. Total complications and reconstruction related complications were similar in both cohorts (5.5% vs. 5.3%, P=0.68 and 4.7% vs. 4.3%, P=0.39, respectively). Multivariate logistic regression revealed body mass index and smoking as independent risk factors for reconstructive complications in both cohorts (P<0.01).
CONCLUSIONS
The NSQIP database provides large-scale, multi-institutional, independent outcomes for acellular dermis and submuscular breast reconstruction. Both thirty-day complication profiles and risk factors for post operative morbidity are similar between these two reconstructive approaches.

Keyword

Alloderm; Mammaplasty; Breast implantation; Tissue expansion devices; Complications

MeSH Terms

Acellular Dermis
Body Mass Index
Breast
Breast Implantation
Cohort Studies
Collagen
Female
Humans
Logistic Models
Mammaplasty
Multivariate Analysis
Prostheses and Implants
Quality Improvement
Risk Factors
Smoke
Smoking
Tissue Expansion Devices
Track and Field
Transplantation, Homologous
Collagen
Smoke