** Please note: this is a tentative submission, requiring approval by Mr C Porter, will liaise with him following RACS ASC 2019**
To review all cases of implant-based breast reconstruction over the last 6 years (2013-2018) performed at our unit, with respect to the use and subtype of acellular dermal matrix (ADM) products, associated risk factors and rates of complications.
To identify cases, a search of the department’s operative database was performed. Demographics including age, comorbidities, smoking status and peri-operative chemo-radiotherapy were recorded. The use of ADM: Alloderm(Al), Strattice(St), Surgimend(Sm) and Veritas(V), and associated complication rates including infection (I), seroma (S), malposition (M) and explantation (E) were analysed.
Two hundred and thirty six implant-based reconstructions were performed in 186 patients. The overall complication rate was 24% (I: 8%, S: 6%, M: 3%, E: 6%). The complication rate in the ADM group was 36% vs non-ADM submuscular: 20%, RRR 1.7 (p:0.17). Peri-operative Smoking, Radiotherapy, Chemotherapy and Hormonal therapy were associated with an 18%, 3%, 24% and 18% rate of complication, respectively. Complication rates for the various ADMs were as follows: Al:18%(S:3 I:6 Ex:9)%, St: 59%(S:20 I:17 M:7 E:7)%, Sm:22% (S:11 I:11)% and V:71%(S:43 I:14 E:14)%.
Higher rates of complications in implant reconstructions are found in the ADM group. Veritas had the overall highest complication rate, particularly in regards to seroma and explantation. Strattice had the highest rate of infection. In our experience we have found that different ADMs have different complication profiles, this combined with aesthetic outcome, patient satisfaction and ADM cost has guided our practice.