Plastic Surgery Research Council
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Presenter: Brett Michelotti, MD
Co-Authors: Brooke S; Mesa J; Wilson M; Moyer K; Mackay D; Neves RI; Potochny J
Pennsylvania State University Milton S Hershey Medical Center

Background: With a rise in tissue expander-based breast reconstructions utilizing ADM, we have seen an increase in ADM specific complications in particular, an increase in seroma formation. In this study, we aimed to evaluate clinically significant seroma formation (CSS) defined by the need for a drainage procedure - to determine if there was a difference in incidence between product types: Alloderm, DermaMatrix, and Flex HD.

Methods: This was a retrospective review of consecutive patients who underwent TEBR at a single institution. The total number of reconstructed breasts was separated into four groups according to the product type: Alloderm (AL), DermaMatrix (DM), FlexHD (FHD), or no ADM. Demographic information was obtained in addition to exposure to chemotherapy, radiation, or tobacco. We identified the total number of clinically significant seromas and compared these data between product types. A logistic regression was performed in an attempt to identify independent risk factors associated with seroma formation.

Results: In total, we identified 284 consecutive tissue expander-based breast reconstructions. Age, BMI, and chemotherapy exposure were similar between groups. Radiation and tobacco use were variable but controlled statistically. Overall, there were 17 seromas in 220 breast reconstructions in which ADM was used (7.7%). When comparing the number of CSS between groups Alloderm (n= 2, 4.0%), DermaMatrix (n = 6, 5.4%), FlexHD (n= 9, 14.75%), no ADM (n=1, 1.5%) we found a significant difference in seroma incidence between product types (p= 0.016). Multivariate analysis identified a strong trend toward FlexHD as an independent predictor of seroma formation (p= 0.061).

Conclusion: Our review suggests that there is strong trend in clinically significant seroma formation with the use of FlexHD as compared to other product types and reconstructions in which no ADM was used. This study ads important data to the growing body of literature examining the safety and efficacy of ADM as an adjunct to tissue expander-based breast reconstruction.

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