Human Acellular Dermis versus Submuscular Tissue Expander Breast Reconstruction: A Multivariate Analysis of Short-Term Complications.
- Author:
Armando A DAVILA
1
;
Akhil K SETH
;
Edward WANG
;
Philip HANWRIGHT
;
Karl BILIMORIA
;
Neil FINE
;
John YS KIM
Author Information
- Publication Type:Original Article
- Keywords: Alloderm; Mammaplasty; Breast implantation; Tissue expansion devices; Complications
- MeSH: Acellular Dermis; Body Mass Index; Breast; Breast Implantation; Cohort Studies; Collagen; Female; Humans; Logistic Models; Mammaplasty; Multivariate Analysis; Prostheses and Implants; Quality Improvement; Risk Factors; Smoke; Smoking; Tissue Expansion Devices; Track and Field; Transplantation, Homologous
- From:Archives of Plastic Surgery 2013;40(1):19-27
- CountryRepublic of Korea
- Language:English
- Abstract: 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 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. Two hundred forty 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% vs. 5.3%, P=0.68 and 4.7% vs. 4.3%, P=0.39, respectively). Multivariate logistic regression revealed body mass index 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.
