Postsurgical Outcomes with Acellular Dermal Matrices for Two-stage Prosthetic Breast Reconstruction in 20,817 Patients

Abstract

PURPOSE: The use of acellular dermal matrices (ADM) for tissue expander breast reconstruction remains controversial with uncertain safety and efficacy profile. This study analyzes the rates and factors for reoperation and postoperative infection in patients who underwent tissue expander breast reconstruction with and without ADM. Methods Patients who underwent breast reconstruction with and without ADM were identified from the NSQIP database utilizing CPT codes. Covariates included patient demographics, preoperative comorbidities, and operative characteristics, while outcomes of interest were postoperative infection and reoperation. A univariate and multivariate analysis were performed to identify predictors of adverse outcomes. RESULTS: There were 8,334 patients in the ADM cohort and 12,451 patients who underwent tissue expander breast reconstruction without ADM. There were significantly fewer reoperations in the non-ADM cohort (5.4%) compared to the ADM cohort (7.7%) (p<0.0001), with infection and hematoma as the most common etiologies in both cohorts. Surgical infections were also more prevalent in the ADM cohort (4.7%) compared to the non-ADM cohort (3.6%) (p<0.0001). Univariate and multivariate analysis of the tissue expander breast reconstruction cohort revealed race, obesity, hypertension, smoking status, albumin, and operative time as predictive for infection risk, while race, obesity, hypertension, smoking, albumin, operative time, and age were significant for reoperation. CONCLUSION: Our study of 20,817 patients revealed significantly higher risk of infection and reoperation in patients who underwent breast reconstruction utilizing ADM compared to those without ADM. Patients considering ADM for breast reconstruction should engage in discussion with their provider about complications, aesthetics, and cost.