Breast Reconstruction with or without Human Acellular Dermal Matrices: A Single-Clinic, Review of Esthetic Outcomes and Risk Factors for Complications

Abstract

Introduction: Immediate breast reconstruction following mastectomy using human acellular dermal matrix (HADM) offers clinical benefits over reconstruction without HADM. However, guidance on HADM use, questions regarding complications, and lack of outcomes and comparison data remain. In this retrospective chart review, clinical outcomes following breast reconstruction with or without HADM and by HADM type are evaluated to address these issues. Materials and Methods: Charts for all patients undergoing breast reconstruction at a single clinic from 2006 to 2011 were collected. Information extracted included baseline patient demographics and disease characteristics, comorbidities, medications, type of HADM in breast reconstruction (FlexHD, AlloDerm, or no HADM), clinical outcomes, and esthetic results. Variables with significant group differences were risk-adjusted in multivariate analyses for postoperative and aesthetic outcomes. Results: A total of 650 patient charts (881 breast reconstructions) were analyzed, with few differences in patient/clinical characteristics between the HADM and no-HADM groups. The most commonly reported clinical complications in all groups were seroma and infections. The AlloDerm group had an increased adjusted risk of complications compared with the no HADM group; the FlexHD group had no significant differences compared with the no-HADM group. Both FlexHD and AlloDerm groups exhibited significantly higher perceived esthetic results compared with the no-HADM group (8.22 and 8.02 vs 6.53, respectively, P < .0001). Conclusions: These results suggest that the enhanced esthetic outcomes with HADM and expanders/implants in breast reconstruction may outweigh the risk of certain surgical complications, especially with FlexHD. Appropriate patient selection based on complication risk factors may further increase the benefit-to-risk ratio for HADM use in breast reconstructions.