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Acellular Dermal Matrix And Prepectoral Two-stage Breast Reconstruction: A Cohort Analysis Of Alloderm, FlexHD And SurgiMend
Jacqueline J. Chu, BA, Kathryn Haglich, MS, Robyn Rubenstein, MD, Cayla McKernan, MS, PA-C, Tajah Bell, MS, Richard T. Poulton, BS, Carrie S. Stern, MD, Joseph J. Disa, MD, Michelle Coriddi, MD, Joseph Dayan, MD, Robert J. Allen, Jr., MD, Babak J. Mehrara, MD, Evan Matros, MD, Jonas A. Nelson, MD.
Memorial Sloan Kettering Cancer Center, New York, NY, USA.

Background: Acellular dermal matrix (ADM) is frequently used in prepectoral breast reconstruction, but few studies have examined its impact on complication risk and even fewer have examined the role of ADM type on complication risk in this patient population, leading to a non-evidence-based approach to ADM selection. The purpose of this study is to determine the risk of complications after immediate, prepectoral, tissue expander (TE) breast reconstruction based on the type of ADM used.
Methods: A retrospective review of post-mastectomy breast reconstruction patients at Memorial Sloan Kettering Cancer Center from 2018-2020 was conducted. All patients had immediate, prepectoral tissue expander reconstruction with use of ADM. Both unilateral and bilateral reconstructions were included. Three types of ADM were compared: 1) Alloderm, 2) FlexHD, and 3) SurgiMend. Complication rates based on the number of tissue expanders were determined for each ADM type. Patient characteristics, including age, race, diabetes, hypertension, and smoking history, cancer treatment characteristics, including chemotherapy and radiotherapy, and surgical characteristics, including mastectomy incision type, axillary lymph node dissection, TE size, and ADM size, were also collected and compared among the three types of ADM. Unadjusted comparisons were conducted using Fisher’s exact or Kruskal-Wallis tests. Multivariate logistic regression was used to determine the impact of ADM type on complication risk after accounting for confounders.
Results: Overall, 506 patients (788 TEs: 148 Alloderm, 86 FlexHD, 554 SurgiMend) were included. The three cohorts differed in terms of laterality (Unilateral: 66.7% of Alloderm, 49.1% of FlexHD, 36.1% of SurgiMend, p<0.001) and mastectomy type (Nipple-sparing: 23.4% of Alloderm, 33.3% of FlexHD, 18.9% of SurgiMend, p=0.047). SurgiMend had the highest overall complication rate (SurgiMend: 23.3%, Alloderm: 19.6%, FlexHD: 11.6%, p=0.037), but no significant differences were noted for seroma, skin flap necrosis, hematoma, infection, TE exposure, TE malposition, or TE loss. After controlling for patient, cancer treatment, and surgical characteristics, no ADM type had higher odds of overall complications or TE loss.
Conclusions: In this large cohort of prepectoral reconstruction patients, we demonstrate that ADM type does not affect risk of complications. Prospective studies are warranted to evaluate ADM choice for prepectoral reconstruction in a head-to-head fashion.


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