Document Detail


The use of acellular dermal matrix in immediate two-stage tissue expander breast reconstruction.
MedLine Citation:
PMID:  22544088     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Acellular dermal matrix is commonly used in implant-based breast reconstruction to allow for quicker tissue expansion with better coverage and definition of the lower pole of the breast. This study was performed to analyze complications associated with its use in immediate two-stage, implant-based breast reconstruction and to subsequently develop guidelines for its use.
METHODS: A retrospective analysis of 628 consecutive immediate two-stage tissue expander breast reconstructions at a single institution over a 3-year period was conducted. The reconstructions were divided into two groups: reconstruction with acellular dermal matrix and reconstruction without it. Demographic information, patient characteristics, surface area of acellular dermal matrix, and complications were analyzed and compared.
RESULTS: A total of 407 patients underwent 628 immediate two-stage, implant-based breast reconstructions; 442 reconstructions (70.3 percent) used acellular dermal matrix and 186 (29.6 percent) did not. The groups had similar patient characteristics; however, major complications were significantly increased in the acellular dermal matrix group (15.3 versus 5.4 percent; p = 0.001). These complications included infection requiring intravenous antibiotics (8.6 versus 2.7 percent; p = 0.001), flap necrosis requiring excision (6.7 versus 2.7 percent; p = 0.015), and explantation of the tissue expander (7.7 versus 2.7 percent; p = 0.004).
CONCLUSIONS: Use of acellular dermal matrix in immediate two-stage, implant-based breast cancer reconstruction is associated with a significant increase in major complications. Therefore, it should only be used in specific patients and in minimal amounts. Indications for its use include single-stage permanent implant reconstruction and inadequate local muscle coverage of the tissue expander.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
Authors:
Katie E Weichman; Stelios C Wilson; Andrew L Weinstein; Alexes Hazen; Jamie P Levine; Mihye Choi; Nolan S Karp
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Plastic and reconstructive surgery     Volume:  129     ISSN:  1529-4242     ISO Abbreviation:  Plast. Reconstr. Surg.     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-04-30     Completed Date:  2012-06-25     Revised Date:  2014-10-13    
Medline Journal Info:
Nlm Unique ID:  1306050     Medline TA:  Plast Reconstr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1049-58     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Breast Implantation / adverse effects*
Breast Implants / adverse effects
Breast Neoplasms / prevention & control,  surgery*
Collagen / adverse effects*,  therapeutic use
Female
Humans
Mammaplasty / adverse effects*,  methods
Mastectomy*
Middle Aged
Retrospective Studies
Tissue Expansion / adverse effects*
Tissue Expansion Devices / adverse effects
Chemical
Reg. No./Substance:
0/Alloderm; 9007-34-5/Collagen
Comments/Corrections
Comment In:
Plast Reconstr Surg. 2012 May;129(5):1059-60   [PMID:  22544089 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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