Plastic Surgery Research Council
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HUMAN ACELLULAR DERMIS VERSUS SUBMUSCULAR TISSUE EXPANDER BREAST RECONSTRUCTION: A MULTIVARIATE ANALYSIS OF SHORT-TERM COMPLICATIONS BASED ON THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (NSQIP) DATABASE
Presenter: Armando Davila, BS
Co-Authors: Seth AK; Wang E; Hanwright PJ; Bilimoria K; Fine N; Kim JY
Northwestern University Feinberg School of Medicine

Background: Acellular dermal matrix (ADM) allografts and their putative benefits have been increasingly described in prosthesis based breast reconstruction. There have been a myriad of analyses outlining ADM complication profiles, but few large-scale, multi-institutional studies exploring these outcomes. In this study, complication rates of acellular dermis-assisted tissue expander breast reconstruction were compared with traditional submuscular methods by evaluation of the American College of Surgeon s (ACS) National Surgical Quality Improvement Program (NSQIP) registry.

Methods: Patients who underwent immediate tissue expander breast reconstruction from 2006-2010 were identified using surgical procedure codes. 240 tracked variables from over 250 participating sites were extracted for patients undergoing acellular dermis-assisted versus submuscular tissue expander reconstruction. Thirty-day postoperative outcomes and captured risk factors for complications were compared between the two groups.

Results: A total of 9,159 patients underwent tissue expander breast reconstruction; 1,717 using acellular dermis and 7,442 with submuscular expander placement. Total complications and reconstruction related complications were similar in both cohorts (5.5% versus 5.3%; p =0.68 and 4.7% versus 4.3%; p =0.39, respectively). Multivariate logistic regression revealed body mass index (BMI) and smoking as independent risk factors for reconstructive complications in both cohorts (p <0.01).

Conclusions: The NSQIP database provides large-scale, multi-institutional, independent outcomes for acellular dermis and submuscular breast reconstruction. Both thirty-day complication profiles and risk factors for post operative morbidity are similar between these two reconstructive approaches.


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