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A Multi-institutional Examination Of Complications Following Prepectoral Tissue Expander Breast Reconstruction With And Without Acellular Dermal Matrix
Jennifer Wang, BS1, Anna Zhou, MD
2, Ariel Gabay, BA
1, Mariam Sharief, BS
2, Lilllian A. Boe, PhD
1, Noa G. Kopplin, BS
2, Babak J. Mehrara, MD
1, Evan Matros, MD MPH MMSc
1, Carrie Stern, MD
1, Joani M. Christensen, MD
2, J Bryce Olenczak, MD
2, Alexander F. Mericli, MD
2, Jonas A. Nelson, MD MPH
1, Ashleigh M. Francis, MD
2.
1Memorial Sloan Kettering Cancer Center, New York, NY, USA,
2MD Anderson Cancer Center, Houston, TX, USA.
PURPOSE Prepectoral tissue expander (TE) placement for two-stage postmastectomy reconstruction is a widely accepted technique with numerous advantages over submuscular placement. Reconstructive success is contingent upon adequate soft tissue coverage, with acellular dermal matrix (ADM) playing an important supportive role as an adjunct. However, the utility of ADM remains a subject of debate due to its substantial cost and inconsistent reported complication rates.
METHODS A multi-institutional propensity score-matched analysis included patients from two cancer centers who underwent immediate prepectoral TE breast reconstruction from January 2018 to June 2022. Patients were grouped by whether ADM was used and matched on data source, age, BMI, smoking status, receipt of chemotherapy, receipt of radiation, and laterality. Outcomes of interest included 90-day rates of infection, seroma, mastectomy skin flap necrosis (MSFN), TE removal, reoperation, and readmission.
RESULTS After matching, 564 patients (282 in each cohort) and 881 breasts were assessed (441 with ADM, 440 with no ADM). Breast-level 90-day rates of infection (5.7% vs 5.9%, p=0.8), seroma (6.3% vs 8.9%, p=0.2), MSFN (3.6% vs 5.5%, p=0.2) , and removal (4.1% vs 5.2%, p=0.6) were comparable between patients in the ADM and no ADM cohort. There were no differences in 90-day rates of reoperation (16% vs 19%, p=0.4) and readmission (3.0% vs 6.3%, p=0.07).
CONCLUSION Rates of early postoperative complications following immediate staged prepectoral reconstruction do not differ with and without ADM. Given the equivalence of early complications, ADM use should be considered on an individualized basis with deliberation of its impact on long-term outcomes.
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