A retrospective review of submuscular implant-based breast reconstruction: The influence of dermal matrix (ADM) on complications and aesthetic outcomes. Issue 11 (November 2022)

• Record Type: Journal Article
• Authors: Kelley, Rebecca S.; Duraes, Eliana F R; Scomacao, Isis R.; Van Dijck, Pauline; Fahradyan, Vahe; Rambhia, Sagar; Moreira, Andrea A.; Djohan, Risal S.; Schwarz, Graham S.; Bernard, Steven L.
• Is Part Of: Journal of plastic, reconstructive & aesthetic surgery. Volume 75:Issue 11(2022)
• Page Start: 4117
• Page End: 4124
• Publication Date: 2022-11
• Subjects: Breast reconstruction -- Acellular dermal matrix -- Submuscular based reconstruction; Surgery, Plastic -- Great Britain -- Periodicals; Reconstructive Surgical Procedures -- Periodicals; Surgery, Plastic -- Great Britain -- Periodicals; 617.9505
• DOI: 10.1016/j.bjps.2022.08.048
• Languages: English
• ISSNs: 1748-6815

Abstract

Summary: Purpose: The use of acellular dermal matrix changed the breast reconstruction algorithm facilitating implant coverage and direct to implant technique. This study aims to evaluate the effect of the ADM surgical complications, breast aesthetics, and patient satisfaction. Methods: In a tertiary hospital, patients that underwent implant-based breast reconstructions during a three-year period had their charts retrospectively reviewed, received post-operative BreastQ, and had their post-operative photos evaluated by a three-member panel using a multi-parameter breast specific scale (scored 1–5). The complication information was analysed per reconstructed breast while the analysis of aesthetic and patient-reported outcomes was done per patient. Results: A total of 501 patients (990 breasts) were evaluated. In the complication analysis group, 20.3% of the breasts had ADM. Overall complications and major complications were more frequent in the ADM group. During the first 30 postoperative days the most frequent complications were: skin necrosis/delayed wound healing and haematoma, after 30 days was infection, and complications after 1 year being less than 1%. On the outcome analysis group, ADM was used in 21.5% patients, 44% had post-operative photos, and 29% answered the BreastQ. Factors associated with higher appearance score were bilateral reconstruction, prophylactic surgery, and nipple presence. ADM demonstrated no difference in satisfaction with breasts. Conclusion: In implant-based breast reconstructions ADM has been shown to increase rate of complications. The use of acellular dermal matrix did not influence the overall appearance or the patient-reported outcome. A good aesthetic outcome is positively influenced by bilateral reconstructions with preservation of the nipple.