TY - JOUR
T1 - Immediate implant-based breast reconstruction with acellular dermal matrix
T2 - A comparison of sterile and aseptic alloderm in 2039 consecutive cases
AU - Parikh, Rajiv P.
AU - Brown, Gabriella M.
AU - Sharma, Ketan
AU - Yan, Yan
AU - Myckatyn, Terence M.
N1 - Funding Information:
Disclosure: Dr. Myckatyn receives investigator-initiated grant funding and consultant and advisory board fees from Allergan, consultant fees from LifeCell, investigator-initiated grant funding and consultant fees from RTI, and advisory board fees from Viveve. None of the authors has any financial disclosures in relation to the content of this article.
Funding Information:
This study was funded by an investigator-initiated grant from LifeCell (principal investigator: Terence M. Myckatyn, M.D., grant number: IIT-2017–10024). Terence M. Myckatyn, M.D., receives investigator-initiated grant funding and consultant and advisory board fees from Allergan, consultant fees from LifeCell, investigator-initiated grant funding and consultant fees from RTI, and advisory board fees from Viveve. Rajiv P. Parikh, M.D., M.P.H.S., received support from a National Institutes of Health Institutional National Research Service Award (T32CA190194). The authors would like to thank Keith Brandt, M.D., and Marissa Tenenbaum, M.D., who along with Dr. Myckatyn, contributed patients to this series. They are grateful to Acel-ity for funding this study. The authors are also grateful to Colleen Kilbourne-Glynn for administrative support for this study and Annette Irving for assistance with institutional review board preparation.
Publisher Copyright:
Copyright © 2018 by the American Society of Plastic Surgeons
PY - 2018
Y1 - 2018
N2 - Background: Sterile ready-to-use acellular dermal matrix, introduced as an alternative to aseptic freeze-dried acellular dermal matrix for implant-based breast reconstruction, has been investigated in a limited number of studies. This study compared outcomes in implant-based breast reconstruction with ready-to-use and freeze-dried acellular dermal matrix. Methods: The authors analyzed patients undergoing implant-based breast reconstruction with either freeze-dried or ready-to-use acellular dermal matrix, including demographics, clinical variables, and outcomes. An a priori power analysis was performed and logistic regression modeling was used to quantify the effect of acellular dermal matrix on outcomes while controlling for potential confounders. Results: A total of 1285 consecutive patients undergoing 2039 immediate prosthetic breast reconstructions constituted the population: 612 (n = 910 breasts) with freeze-dried matrix and 673 (n = 1129 breasts) with ready-to-use acellular dermal matrix. The freeze-dried matrix cohort had a significantly higher rate of explantation compared with the ready-to-use matrix cohort (18.0 percent versus 12.0 percent; p = 0.0036), but surgical-site infection, wound dehiscence, mastectomy flap necrosis, seroma, and hematoma did not differ significantly between groups. On multivariate regression, patients undergoing reconstruction with freeze-dried matrix, compared to ready-to-use matrix, did not have higher odds of experiencing surgical-site infections (OR, 1.064; p = 0.7455), but did have higher odds of explantation (OR, 1.570; p = 0.0161). Tobacco use (OR, 2.809; p = 0.0002) and body mass index (OR, 1.054; p < 0.0001) were also independent predictors of explantation. Conclusion: Immediate implant-based breast reconstruction with sterile ready-to-use acellular dermal matrix has a comparable overall safety profile and a lower rate of prosthetic explantations compared with aseptic freeze-dried acellular dermal matrix.
AB - Background: Sterile ready-to-use acellular dermal matrix, introduced as an alternative to aseptic freeze-dried acellular dermal matrix for implant-based breast reconstruction, has been investigated in a limited number of studies. This study compared outcomes in implant-based breast reconstruction with ready-to-use and freeze-dried acellular dermal matrix. Methods: The authors analyzed patients undergoing implant-based breast reconstruction with either freeze-dried or ready-to-use acellular dermal matrix, including demographics, clinical variables, and outcomes. An a priori power analysis was performed and logistic regression modeling was used to quantify the effect of acellular dermal matrix on outcomes while controlling for potential confounders. Results: A total of 1285 consecutive patients undergoing 2039 immediate prosthetic breast reconstructions constituted the population: 612 (n = 910 breasts) with freeze-dried matrix and 673 (n = 1129 breasts) with ready-to-use acellular dermal matrix. The freeze-dried matrix cohort had a significantly higher rate of explantation compared with the ready-to-use matrix cohort (18.0 percent versus 12.0 percent; p = 0.0036), but surgical-site infection, wound dehiscence, mastectomy flap necrosis, seroma, and hematoma did not differ significantly between groups. On multivariate regression, patients undergoing reconstruction with freeze-dried matrix, compared to ready-to-use matrix, did not have higher odds of experiencing surgical-site infections (OR, 1.064; p = 0.7455), but did have higher odds of explantation (OR, 1.570; p = 0.0161). Tobacco use (OR, 2.809; p = 0.0002) and body mass index (OR, 1.054; p < 0.0001) were also independent predictors of explantation. Conclusion: Immediate implant-based breast reconstruction with sterile ready-to-use acellular dermal matrix has a comparable overall safety profile and a lower rate of prosthetic explantations compared with aseptic freeze-dried acellular dermal matrix.
UR - http://www.scopus.com/inward/record.url?scp=85057521811&partnerID=8YFLogxK
U2 - 10.1097/PRS.0000000000004968
DO - 10.1097/PRS.0000000000004968
M3 - Article
C2 - 30204676
AN - SCOPUS:85057521811
SN - 0032-1052
VL - 142
SP - 1401
EP - 1409
JO - Plastic and Reconstructive Surgery
JF - Plastic and Reconstructive Surgery
IS - 6
ER -