An Algorithmic Approach for Selective Acellular Dermal Matrix Use in Immediate Two-Stage Breast Reconstruction
- 1 August 2014
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Plastic and Reconstructive Surgery
- Vol. 134 (2), 178-188
- https://doi.org/10.1097/prs.0000000000000366
Abstract
Acellular dermal matrix use has gained widespread acceptance--despite higher material costs--because of its ease of use and potential for enhanced cosmesis. The authors developed a resource-sensitive algorithm for selective acellular dermal matrix use with indications and contraindications based on body mass index, breast size, radiation therapy, flap vascularity, and pectoralis anatomy. The algorithm incorporates preoperative and intraoperative decision points. Complication rates and aesthetic scores were compared for procedures performed before and after adoption of the algorithm. Multiple logistic regression was used to determine the independent influence of the algorithm on postoperative outcomes. One hundred ninety-three breasts underwent reconstruction before and 179 underwent reconstruction after implementation of the algorithm. Overall complication rates did not differ between the cohorts (22.8 percent versus 20.7 percent; p=0.138). After adjusting for potential confounders, the algorithm did not significantly affect the incidence of infection, seroma, flap necrosis, explantation, or overall complications (all p>0.05). Aesthetic scores were not affected (2.75 of 4 versus 3.03 of 4; p=0.138). Acellular dermal matrix use decreased from 84 percent to 36 percent, resulting in a materials cost savings of $270,000 over the study period. This algorithm obviated placement of acellular dermal matrix in an estimated 48 percent of immediate tissue-expander reconstructions. Patients treated after adoption of this algorithm experienced similar complication rates and aesthetic outcomes as those who underwent reconstruction before. The authors' preliminary outcomes demonstrate that evidence-based measures can be taken to selectively use acellular dermal matrix without a concomitant worsening of patient outcomes. Therapeutic, III.Keywords
This publication has 46 references indexed in Scilit:
- Impact of Surgical Techniques, Biomaterials, and Patient Variables on Rate of Nipple Necrosis after Nipple-Sparing MastectomyPlastic and Reconstructive Surgery, 2013
- Subjective versus objective assessment of breast reconstructionJournal of Plastic, Reconstructive & Aesthetic Surgery, 2013
- The Use of Acellular Dermal Matrix in Immediate Two-Stage Tissue Expander Breast ReconstructionPlastic and Reconstructive Surgery, 2012
- A Systematic Review and Meta-Analysis of Complications Associated With Acellular Dermal Matrix-Assisted Breast ReconstructionAnnals of Plastic Surgery, 2012
- Retrospective Review of 331 Consecutive Immediate Single-Stage Implant Reconstructions with Acellular Dermal MatrixPlastic and Reconstructive Surgery, 2011
- Acellular Dermis–Assisted Prosthetic Breast ReconstructionPlastic and Reconstructive Surgery, 2011
- Acellular Dermal Matrix in Primary Breast ReconstructionAesthetic Surgery Journal, 2011
- The Effect of Acellular Dermal Matrix Use on Complication Rates in Tissue Expander/Implant Breast ReconstructionAnnals of Plastic Surgery, 2010
- Implant-Based Breast Reconstruction Using Acellular Dermal Matrix and the Risk of Postoperative ComplicationsPlastic and Reconstructive Surgery, 2010
- Expander/Implant Reconstruction with AlloDerm: Recent ExperiencePlastic and Reconstructive Surgery, 2009