Acellular Dermal Matrix in Immediate Expander/Implant Breast Reconstruction: A Multicenter Assessment of Risks and Benefits

Abstract

Sir: We read with great interest the article entitled “Acellular Dermal Matrix in Immediate Expander/Implant Breast Reconstruction: A Multicenter Assessment of Risks and Benefits” by Sorkin et al.1 in Plastic and Reconstructive Surgery. The authors presented the multicenter results of using acellular dermal matrix in tissue expander placement for immediate breast reconstruction. We appreciate this work a lot and want to ask the authors some questions. In this study, the authors analyzed the complications (e.g., wound infection, hematoma, implant malposition), but there were no data regarding skin rupture, breast contour, or lower pole projection2 that may be directly associated with the use of acellular dermal matrix. We want to know whether there were significant differences of these related complications after the use of acellular dermal matrix. There are no standard criteria regarding whether or not to use acellular dermal matrix, which is currently dependent on surgeons’ preferences. The authors stated in this study that approximately one in three surgeons used acellular dermal matrix in 20 to 80 percent of their patients. We would appreciate it if the authors would summarize the criteria these surgeons use to determine use of acellular dermal matrix, which may be beneficial for us. In addition, as we all know, placing a tissue expander is only a temporary step that will be replaced by an implant. The replacement procedure included resection of the capsule. As the capsule is adjacent to acellular dermal matrix, we want to know whether the capsular resection procedure has a negative effect on the existing acellular dermal matrix. We also want to know whether there is any negative effect if the acellular dermal matrix is placed in the second procedure when the expander is replaced by the implant. In conclusion, the authors presented a multicenter study analyzing the results of using acellular dermal matrix in tissue expander placement. The authors leave us wondering whether acellular dermal matrix is really cost-effective. We expect further long-term, large-sample, high-quality studies that provide more information in the future. DISCLOSURE The authors have no financial interest to declare in relation to content of this communication. No funding was received for this work. Shangshan Li, M.D.Jie Luan, M.D.Department of Aesthetic and Reconstructive Breast SurgeryPlastic Surgery HospitalChinese Academy of Medical SciencesPeking Union Medical CollegeBeijing, People’s Republic of China