Utility of Acellular Dermis–Assisted Breast Reconstruction in the Setting of Radiation: A Comparative Analysis

• Published in: Plastic and reconstructive surgery (1963) Vol. 130; no. 4; pp. 750 - 758
• Main Authors: Seth, Akhil K., Hirsch, Elliot M., Fine, Neil A., Kim, John Y. S.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD American Society of Plastic Surgeons 01-10-2012; Lippincott Williams & Wilkins
• Subjects: Acellular Dermis - statistics & numerical data; Adult; Biological and medical sciences; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; Cohort Studies; Female; Follow-Up Studies; Graft Rejection; Graft Survival; Humans; Mammaplasty - adverse effects; Mammaplasty - methods; Mastectomy - methods; Mastectomy, Subcutaneous - methods; Medical sciences; Middle Aged; Multivariate Analysis; Odds Ratio; Postoperative Complications - physiopathology; Postoperative Complications - surgery; Postoperative Period; Radiotherapy, Adjuvant; Regression Analysis; Retrospective Studies; Risk Assessment; Skin Transplantation - adverse effects; Skin Transplantation - methods; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Tissue Expansion; Tissue Expansion Devices; Treatment Outcome; Wound Healing - physiology; Plasty; Breast; Treatment; Derm; Surgery; Comparative study
• ISSN: 0032-1052; 1529-4242
• DOI: 10.1097/PRS.0b013e318262f009

The role of acellular dermis in immediate prosthetic breast reconstruction remains unclear, particularly within a radiated field. The authors evaluated and compare outcomes following reconstruction with and without acellular dermis, and analyzed patients exposed to radiation therapy.
Retrospective review of 417 consecutive patients (592 breasts) treated from January of 2006 to October of 2008 at one institution was performed. Relevant patient characteristics and follow-up were recorded. Complications were categorized by type and end outcome, including nonoperative, operative, or explantation. Both groups had comparable follow-up (acellular dermis, 23.2 ± 8.9 months; no acellular dermis, 24.4 ± 12.7 months; p = 0.23). Appropriate statistical analyses, including multiple regression, were performed.
Acellular dermis patients (n = 199 breasts) had larger body mass indexes (p = 0.0001) and more nipple-sparing mastectomies (p = 0.04) than non-acellular dermis patients (n = 393 breasts). Breasts with acellular dermis had larger intraoperative fill volumes (p < 0.0001) and decreased postoperative expansions (p = 0.02), but no decrease in time to implant exchange. There were no significant differences in complication profiles between acellular dermis and non-acellular dermis breasts, after adjusting for other relevant patient variables on regression analysis. After stratifying patients by exposure to radiation, acellular dermis breasts had a decreased risk of all complications related to radiation as compared with non-acellular dermis breasts.
This study suggests that acellular dermis does not adversely affect complication rates following prosthetic breast reconstruction. It may be advantageous, however, in select patients, particularly those undergoing postoperative radiation therapy. Therefore, the choice to use acellular dermis does not compromise outcomes but should be individualized to each patient.