Summary
Background
Although acellular dermal matrix (ADM) is widely used in expander-implant-based breast
reconstructions, previous analyses have been unable to demonstrate improvements in
patient-reported outcomes (PROs) with this approach over non-ADM procedures. This
study aims to develop a more selective, evidence-based approach to the use of ADM
in expander-implant-based breast reconstruction by identifying patient subgroups in
which ADM improved clinical outcomes and PROs.
Study design
The Mastectomy Reconstruction Outcomes Consortium Study prospectively evaluated immediate
expander-implant reconstructions at 11 centers from 2012 to 2015. Complications (any/overall
and major), and PROs (satisfaction, physical, psychosocial, and sexual well-being)
were assessed two years postoperatively using medical records and the BREAST-Q, respectively.
Using mixed-models accounting for centers and with interaction terms, we analyzed
for differential ADM effects across various clinical subgroups, including age, body
mass index, radiation timing, and chemotherapy.
Results
Expander-implant-based breast reconstruction was performed in 1451 patients, 738 with
and 713 without ADM. Major complication risk was higher in ADM users vs. nonusers
(22.9% vs. 16.4% and p = 0.04). Major complication risk with ADM increased with higher BMI (BMI=30, OR=1.70;
BMI=35, OR=2.29, interaction p = 0.02). No significant ADM effects were observed for breast satisfaction, psychosocial,
sexual, and physical well-being within any subgroups.
Conclusion
In immediate expander-implant-based breast reconstruction, ADM was associated with
a greater risk of major complications, particularly in high-BMI patients. We were
unable to identify patient subgroups where ADM was associated with significant improvements
in PROs. Given these findings and the financial costs of ADM, a more critical approach
to the use of ADM in expander-implant reconstruction may be warranted.
Keywords
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Article Info
Publication History
Published online: October 21, 2020
Accepted:
October 10,
2020
Received:
February 29,
2020
Footnotes
This study was presented as a podium presentation at the 64th Plastic Surgery Research Council Meeting held from May 2nd–5th, 2019.
Identification
Copyright
© 2020 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
