Comparing Complication Rates In Prepectoral Tissue Expanders With And Without Acellular Dermal Matrix Utilization
Ethan L. Plotsker, BA, Francis D. Graziano, MD, Jonas A. Nelson, MD, MPH, Robyn N. Rubenstein, MD, Jacqueline J. Chu, MD, Michelle Coriddi, MD, Joseph H. Dayan, MD, Evan Matros, MD, MPH, MMSc, Joseph J. Disa, MD.
Memorial Sloan Kettering Cancer Center, New York, NY, USA.
PURPOSE: Prepectoral tissue expander (TE) placement for two-stage postmastectomy reconstruction is a widely accepted technique with numerous advantages over submuscular placement, including decreased animation deformity. Reconstructive success is contingent upon adequate soft-tissue coverage, with acellular dermal matrix (ADM) playing an important supportive role as an adjunct. As few studies have examined outcomes of prepectoral TEs with and without ADM, the aim of this study was to compare complications based on ADM usage.
METHODS: We performed a retrospective cohort study of all patients receiving prepectoral reconstruction from 2018-2020. Variables of interest included age, smoking status, BMI, and comorbidities. The primary outcome was TE loss; secondary outcomes included 90-day complications such as capsular contracture, exposure, infection, full-thickness mastectomy skin flap necrosis requiring revision, and seroma. Student t-test was used for continuous variables, and Fischer's exact test for categorical variables.
RESULTS: We examined 574 patients (952 total TEs) in our analysis. Baseline demographics and did not differ significantly across patients with and without ADM, though breast weight was higher in patients without ADM (685.7g vs. 543.2g, p<0.001). Rates of TE loss were similar in both groups (No ADM: 5.45%; ADM: 4.44%, p=0.65). Secondary outcomes of interest did not differ significantly between the cohorts.
CONCLUSION: This review of outcomes in prepectoral TEs with and without ADM showed no significant differences in complication profiles, most notably TE loss. This suggests that in properly selected patients, prepectoral breast reconstruction can be performed safely without ADM. Further work should examine long-term patient-reported outcomes following the exchange operation.
Back to 2022 Resident Posters