American Association of Plastic Surgeons

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Selecting an Acellular Dermal Matrix for Breast Reconstruction: A Comparative Analysis of Complication Rates in Various Adms
Keith Sweitzer, MD, Raquel Arias-Camison, BS, Howard Langstein, MD
University of Rochester, Rochester, NY, USA

PURPOSE: As the popularity of pre-pectoral breast reconstruction has increased, acellular dermal matrices (ADMs) have become a widely accepted adjuvant to implant based breast reconstruction. Many ADMs are available for use, each with differing costs, and properties. We looked to compare different ADMs to determine any significant differences in complication profiles.
METHODS: A single surgeon’s experience from 2018-2023 was analyzed. Patient demographics were obtained without statistically significant variables between treatment groups. Four different ADMs were analyzed, Restella, Cortiva , Ovitex, and Alloderm. 90 day minor complications (Not requiring return to the operating room (RTOR)) and major complications (requiring RTOR) were analyzed. Breast surgeons were noted. Patients with direct to implant were excluded. Chi squared testing and ANOVA testing was performed. Nipple sparing, transverse, wise pattern and IMF incisions were analyzed.
RESULTS: Of 136 total patients who met inclusion criteria (prepectoral reconstruction, tissue expander placement) 68 used Ovitex, 18 used Cortiva, 16 used Restella and 60 used Alloderm. No significant difference was found between the groups for minor complications (p=0.34) or major complications (p=0.24). There was no significant difference between different incision types for minor complications (p=0.17) or RTOR (p=0.75). Of 11 breast surgeons, one had a significant difference in RTOR compared to the others (P=0.009).
CONCLUSION: Many different ADMs exist that are utilized in implant based breast reconstruction. There are not significant differences in these for minor or major complications. ADM selection should be based on institutional costs value analysis, and surgeon preference.


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