Alternatives to ADM: Utilization of a Gore DualMesh Sling as a Cost Conscious Adjunct for Breast Reconstruction
Jacob N. Grow, M.D.1, James Butterworth, M.D.1, Paul Petty, M.D.2.
1Univeristy of Kansas Medical Center Department of Plastic Surgery, Kansas City, MO, USA, 2Mayo Clinic Division of Plastic Surgery, Rochester, MN, USA.
PURPOSE:This study seeks an alternative to acellular dermal matrix (ADM) in two staged breast reconstruction while minimizing cost. It was hypothesized that use of a Gore DualMesh would allow for similar intraoperative tissue expander fill volumes, time to 2nd stage, and number of post-operative fills compared to ADM at only a fraction of the expense.
METHODS:Retrospective analysis comparing Gore DualMesh (34 patients, 59 breasts), ADM (8 patients, 13 breasts) and total muscle coverage (14 patients, 25 breasts) for post-mastectomy breast reconstruction was performed. Time to 2nd stage, number of expansions, and relative initial fill volumes were compared between the 3 groups. Complication rates were also considered, including seroma, infection, expander/implant explantation, removal of mesh, and capsular contracture. Statistical analysis was performed utilizing Fisher exact test and chi-squared test for categorical variables and Mann-Whitney U test for continuous variables.
RESULTS:Time to 2nd stage, number of expansions, and relative initial fill volumes showed no statistical difference between the ADM and Gore DualMesh groups (p=0.539, 0.146 and 0.494 respectively). Furthermore, the Gore DualMesh group underwent significantly fewer fills (p<0.001) and had a higher relative initial fill volume (p<0.001) compared to total muscle coverage. The additional cost per breast as a result of including DualMesh was on average $385 versus $4287 for ADM. Complication rates were similar between all three groups without statistically significant differences.
CONCLUSION:Gore DualMesh represents a safe alternative to ADM for breast reconstruction with similar aesthetic results at a fraction of the cost.
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