The Deepithealized Autodermal Flap With And Without The Use Of Acellular Dermal Matrix In Skin-reducing Wise Pattern Mastectomy And Immediate Breast Reconstruction.
Alexandra M. Hart, M.D., Grant W. Carlson, M.D..
Emory University School of Medicine, Atlanta, GA, USA.
Purpose: The use of a deepithealized autodermal flap in breast reconstruction with acellular dermal matrix (ADM) may reduce complications in women with macromastia undergoing implant-based immediate BR. The purpose of our study is to analyze the complications of this technique with and without ADM.
Methods: Patients were from a single breast and reconstructive surgeon and had bilateral skin-sparing mastectomy with a skin-reduction Wise pattern and immediate sub-pectoral tissue expander (n=67 patients; 125 breasts). The inferior mastectomy flap was de-epithelized for all patients and used in addition to ADM or solely as an inferior sling. Complications and patient demographics were analyzed.
Results: ADM was used in 61.6% of patients(n=77). The mean mastectomy weight was significantly lower in the ADM group (713g vs. 970g, p=0.004).
When analyzed per patient, BMI>30 trended toward higher rate of complications (55.6% vs. 32.5%, p=0.079) and significantly higher rates of skin necrosis (37.0% vs. 15.0%, p=0.046). The mean mastectomy weight was significantly higher in patients that had any complication (p=0.003).
When analyzed per breast, BMI>30 was significantly associated with a higher incidence of complications (p=0.004). The mean mastectomy weight was significantly associated with major complications (p=<0.001), reconstructive failure (p=0.015), implant failure due to malposition/flipping (p=0.019), and skin necrosis (p<0.0001).
| Risk factor | Skin flap necrosis | P-value | Reconstructive failure | P-value |
| BMI | ||||
| <30 | 25% | 1.3% | ||
| >30 | 41.7% | 0.073 | 12.3% | 0.033 |
| ADM | ||||
| No | 41.7% | 4.2% | ||
| Yes | 25.0% | 0.073 | 6.5% | NS |
Conclusion: BMI>30, increasing mastectomy weights, and use of a dermal flap alone increased the risk the complications after skin reducing mastectomy and BR.
Back to 2020 Posters
