Acellular Dermal Matrix And Prepectoral Two-stage Breast Reconstruction: A Cohort Analysis Of Alloderm, FlexHD And SurgiMend
Jacqueline J. Chu, BA, Kathryn Haglich, MS, Robyn Rubenstein, MD, Cayla McKernan, MS, PA-C, Tajah Bell, MS, Richard T. Poulton, BS, Carrie S. Stern, MD, Joseph J. Disa, MD, Michelle R. Coriddi, MD, Joseph H. Dayan, MD, Robert J. Allen, Jr., MD, Babak J. Mehrara, MD, Evan Matros, MD, MPH, MMSc, Jonas A. Nelson, MD, MPH.
Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Purpose: Acellular dermal matrix (ADM) is frequently used in prepectoral breast reconstruction, but few studies have examined the role of ADM type on complication risk. This study determines the impact of ADM type on complication rates in prepectoral, tissue expander (TE) breast reconstruction. Methods: A review of breast reconstruction patients at Memorial Sloan Kettering Cancer Center from 2018-2020 was conducted. All patients had immediate, prepectoral TE reconstruction with Alloderm, FlexHD, or SurgiMend. Complication rates based on number of TEs were determined for each ADM type. Patient, cancer treatment, and surgical characteristics were also compared. Multivariate logistic regression was used to determine the impact of ADM type on complication risk after accounting for confounders. Results: Overall, 506 patients (788 TEs: 148 Alloderm, 86 FlexHD, 554 SurgiMend) were included. The three cohorts differed in terms of laterality (Unilateral: 66.7% of Alloderm, 49.1% of FlexHD, 36.1% of SurgiMend, p<0.001) and mastectomy type (Nipple-sparing: 23.4% of Alloderm, 33.3% of FlexHD, 18.9% of SurgiMend, p=0.047). SurgiMend had the highest overall complication rate (SurgiMend: 23.3%, Alloderm: 19.6%, FlexHD: 11.6%, p=0.037), but no significant differences were noted for seroma, skin flap necrosis, hematoma, infection, TE exposure, TE malposition, or TE loss. After controlling for patient, cancer treatment, and surgical characteristics, no ADM type had higher odds of overall complications or TE loss. Conclusions: In this large cohort of prepectoral reconstruction patients, we demonstrate that ADM type does not affect risk of complications. Prospective studies are warranted to evaluate ADM choice for prepectoral reconstruction in a head-to-head fashion.
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