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Development of an evidence-based approach to the use of acellular dermal matrix in immediate expander-implant-based breast reconstruction

  • Nishant Ganesh Kumar
    Affiliations
    Section of Plastic Surgery, Department of Surgery, University of Michigan, 1500 E. Medical Center Drive, 2130 Taubman Center, SPC 5340, Ann Arbor, MI, United States
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  • Nicholas L. Berlin
    Affiliations
    Section of Plastic Surgery, Department of Surgery, University of Michigan, 1500 E. Medical Center Drive, 2130 Taubman Center, SPC 5340, Ann Arbor, MI, United States

    National Clinician Scholars Program, University of Michigan Institute for Healthcare Policy and Innovation, 2800 Plymouth Rd, North Campus Research Complex, Building 16, Ann Arbor, MI United States
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  • Hyungjin M. Kim
    Affiliations
    Center for Statistical Consultation and Research, Department of Biostatistics, 915 E. Washington St., 3550 Rackham, Ann Arbor, MI, United States
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  • Jennifer B. Hamill
    Affiliations
    Section of Plastic Surgery, Department of Surgery, University of Michigan, 1500 E. Medical Center Drive, 2130 Taubman Center, SPC 5340, Ann Arbor, MI, United States
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  • Jeffrey H. Kozlow
    Affiliations
    Section of Plastic Surgery, Department of Surgery, University of Michigan, 1500 E. Medical Center Drive, 2130 Taubman Center, SPC 5340, Ann Arbor, MI, United States
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  • Edwin G. Wilkins
    Correspondence
    Corresponding author.
    Affiliations
    Section of Plastic Surgery, Department of Surgery, University of Michigan, 1500 E. Medical Center Drive, 2130 Taubman Center, SPC 5340, Ann Arbor, MI, United States
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Published:October 21, 2020DOI:https://doi.org/10.1016/j.bjps.2020.10.005

      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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