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Use of Acellular Dermal Matrix in Breast Reconstruction is Associated With a Small, But Significant Increase in Tissue Expander/Implant Loss: an Analysis of the TOPS Database
Christopher J. Pannucci, MD MS1, Anuja K. Antony, MD MPH2, Edwin G. Wilkins, MD MS1.
1University of Michigan, Ann Arbor, MI, USA, 2University of Illinois-Chicago, Chicago, IL, USA.

PURPOSE: Use of acellular dermal matrix (ADM) in breast reconstruction has been associated with increased complications and expander/implant loss. However, existing studies are generally small, from single centers, and underpowered to control for confounding using regression techniques. Here, we utilized the Tracking Outcomes and Operations in Plastic Surgery (TOPS) database to examine the effect of ADM on expander/implant loss when controlling for other confounders.
METHODS: Analysis was limited to patients having tissue expander or implant-based breast reconstruction. Surgeon-reported data, ICD-9 codes, and CPT codes were used to identify independent variables. Independent variables are shown in Table 1. The dependent variable of interest was 30-day rates of tissue expander or implant loss. Multivariable logistic regression identified independent predictors of expander/implant loss when controlling for other confounders.
RESULTS: Data was available for 14,249 patients. The overall rate of expander/implant loss was 2.05%. Bivariate analysis demonstrated ADM was associated with an absolute increase in expander/implant loss of 0.7% (1.88% vs. 2.58%, p=0.012). 8,746 patients had complete data and were placed into the regression model. When compared to the reference group, BMI of 30-40 (OR 1.90, 95% CI 1.38-2.61, p<0.001) and ≥40 (OR 4.24, 95% CI 2.66-6.76, p<0.001) were independent predictors of expander/implant loss. Additional independent predictors included current smoker (OR 1.67, 95% CI 1.11-2.50, p=0.014) and diabetes (OR 1.72, 95% CI 1.02-2.88, p=0.041). When controlling for all other identified confounders, use of ADM was associated with significant increase in expander/implant loss (OR 1.42, 95% CI 1.04-1.94, p=0.026). There was a significant decrease in observed rates of tissue expander/implant loss over time (Figure 1).
CONCLUSIONS: Among the general population, 30-day risk for expander/implant loss after expander/implant based breast reconstruction was 2.05%. Use of ADM was associated with a 0.7% absolute risk increase for expander/implant loss (1.88% to 2.58%).:


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