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. 2013 Jan;40(1):19-27.
doi: 10.5999/aps.2013.40.1.19. Epub 2013 Jan 14.

Human Acellular Dermis versus Submuscular Tissue Expander Breast Reconstruction: A Multivariate Analysis of Short-Term Complications

Armando A Davila  1 , Akhil K Seth, Edward Wang, Philip Hanwright, Karl Bilimoria, Neil Fine, John Ys Kim
Affiliations

Human Acellular Dermis versus Submuscular Tissue Expander Breast Reconstruction: A Multivariate Analysis of Short-Term Complications

Armando A Davila et al. Arch Plast Surg. 2013 Jan.

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.

Keywords: Alloderm; Breast implantation; Complications; Mammaplasty; Tissue expansion devices.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Study attrition diagram The study attrition diagram depicts a summary of the inclusion and exclusion criteria process. NSQIP, National Surgical Quality Improvement Program; ADM, acellular dermal matrix.
Fig. 2
Fig. 2
Risk adjusted odds for postoperative complications Risk adjusted odds for complications for acellular dermis versus submuscular breast reconstruction. Size of the solid squares is inversely proportional to the variance in the population. The dashed line represents the 95% confidence interval (CI).
Fig. 3
Fig. 3
Risk factor comparison for complications Comparison of risk factors for complications in both acellular dermis and submuscular breast reconstruction cohorts. Size of the solid squares is inversely proportional to the variance in the population. The dashed line represents the 95% confidence interval (CI).
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