Increased Complications in Prosthetic-Based Breast Reconstruction with Alloderm Compared to Total Muscle Coverage
Marilyn Ng, MD, Eric I. Chang, MD.
Fox Chase Cancer Center, Rockledge, PA, USA.
PURPOSE: Prosthetic breast reconstruction is the most common method in the treatment of patients undergoing mastectomy. The use of Alloderm acellular dermal matrix has become more popular in recent years for implant-based breast reconstruction.
METHODS: A retrospective review was performed of all patients undergoing prosthetic breast reconstruction between August 2002 and December 2013. Patients were analyzed in terms of demographics, fill volumes, number of expansions, costs, and complications. Long term follow-up beyond 2 years was performed to assess rates of revisions.
RESULTS: A total of 277 patients underwent placement of 466 breast tissue expanders. Although the total overall complication rate was not significantly different between the Alloderm and Total Muscle (TM) groups (31.4% vs. 21.5%, p>0.05), the rate of major complications was significantly higher with Alloderm (26.7% vs. 11.7%, p<.004). The mean initial fill volume was significantly lower in TM compared to Alloderm group (54±47 vs. 167±139, p=0.00003) resulting in a higher number of expansions in patients with total muscle coverage (7.7 vs. 6.1, p=0.00076). However, there was no difference in time to exchange for permanent implant (160.4 vs. 165.8 days, p>0.05). There is also an increased rate of revisions with Alloderm after average follow-up of 55.7 months (10.7% vs. 4.4%, p<0.01). Use of Alloderm added a mean cost of $2,217 for each breast.
CONCLUSION: Although the use of Alloderm allows increased initial fill volumes and fewer total expansions, this study shows an increased risk of major complications as well as considerable added cost without the touted benefits of decreasing revisions or time to expander exchange. Total muscle coverage remains an excellent option for providing quality breast reconstruction without increased complications.
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