Association between ADM Thickness and Complication Risks in Tissue Expander Breast Reconstruction

Abstract

PURPOSE: Tissue-expander breast reconstruction (TEBR) is the most common method of reconstruction following mastectomy. The use of acellular dermal matrix (ADMs) during this procedure allows implants to be better supported and placed in the prepectoral plane. However, ADMs have been associated with increased complication. One of the factors to consider during the process of reconstruction is ADM selection—surgeons have a variety of options to choose from, all with different specifications. Although work has been done in comparing ADM brands, there is a paucity of data regarding the importance of ADM thickness. In this study, we examine the association of ADM thickness with complications in TEBR. METHODS: A retrospective review was conducted on patients undergoing immediate TEBR with ADM from 2010 to 2019. Patients were divided based on thickness of ADM: 0.53 mm–1.2 mm (Group 1) versus greater than 1.2 mm (Group 2). Patients undergoing delayed or autologous reconstruction, or TEBR without ADM, were excluded. Only complications occurring between Stage 1 and Stage 2 of reconstruction were examined. RESULTS: In total, 228 reconstructions (137 patients) were included in the study: Group 1 included 134 reconstructions (80 patients), and Group 2 included 94 reconstructions (57 patients). Group 2 had a significantly higher rate of diabetes mellitus II than Group 1 (0% versus 7.1%, P = 0.016). Logistic regression did not reveal diabetes mellitus II to increase the likelihood of any of the complications studied. There was otherwise no significant difference in age, body mass index, tobacco use, hypertension, and radiation exposure before or after reconstruction, or in chemotherapy before or after reconstruction, between the two groups. Comparison of complications between individually reconstructed breasts in Group 1 versus Group 2 revealed significantly increased rates of skin necrosis (3.0% versus 10.6%, P = 0.018) among Group 2 breasts. Rates of infection were also increased among Group 2 (10.4% versus 18.1%, P = 0.098), which approached significance. There was no difference in reconstructive failure, conversion to autologous reconstruction, seroma, wound dehiscence, hematoma, or fat necrosis between the two groups. Logistic regression further revealed greater ADM thickness to be a significant predictor of skin necrosis (OR 3.869, 95% CI 1.175–12.738). CONCLUSIONS: To date, this study represents the largest analysis of the effect of ADM thickness on complications after TEBR and the first to show a significant difference in complications with bivariate analysis. Thicker ADMs were significantly correlated with increased rates of skin necrosis, though there may not likely be a direct causality in this relationship. The increased infection rate, though not significant, may be caused by the potential for the ADM to act as a nidus for infection as well as prolonged time of thicker ADM incorporation and neovascularization. Our results, similar to previous studies conducted on smaller patient samples,1 show that ADM thickness does indeed play a role in complication rates, and selection of ADM should be conducted carefully. REFERENCE: 1. Rose JF, Zafar SN, Ellsworth Iv WA. Does Acellular dermal matrix thickness affect complication rate in tissue expander based breast reconstruction?. Plast Surg Int. 2016;2016:2867097. doi:10.1155/2016/2867097