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The effects of acellular dermal matrix in expander-implant breast reconstruction after total skin-sparing mastectomy: results of a prospective practice improvement study.

Publication ,  Journal Article
Peled, AW; Foster, RD; Garwood, ER; Moore, DH; Ewing, CA; Alvarado, M; Hwang, ES; Esserman, LJ
Published in: Plast Reconstr Surg
June 2012

BACKGROUND: Neither outcome after total skin-sparing mastectomy and expander-implant reconstruction using acellular dermal matrix nor a strategy for optimal acellular dermal matrix selection criteria has been well described. METHODS: Prospective review of three patient cohorts undergoing total skin-sparing mastectomy with preservation of the nipple-areola complex and immediate expander-implant reconstruction from 2006 to 2010 was performed. Cohort 1 (no acellular dermal matrix) comprised 90 cases in which acellular dermal matrix was not used. Cohort 2 (consecutive acellular dermal matrix) included the next 100 consecutive cases, which all received acellular dermal matrix. Cohort 3 (selective acellular dermal matrix) consisted of the next 260 cases, in which acellular dermal matrix was selectively used based on mastectomy skin flap thickness. Complication rates were compared using chi-square analysis. RESULTS: The study included 450 cases in 288 patients. Mean follow-up was 25.5 months. Infection occurred in 27.8 percent of the no-acellular dermal matrix cases, 20 percent of the consecutive cases, and 15.8 percent of the selective cases (p = 0.04). Unplanned return to the operating room was required in 23.3, 11, and 10 percent of cases, respectively (p = 0.004). Expander-implant loss occurred in 17.8, 7, and 5 percent of cases, respectively (p = 0.001). Additional analysis of the odds ratios of developing complications after postmastectomy radiation therapy demonstrated a specific protective benefit of acellular dermal matrix in irradiated patients. CONCLUSIONS: Acellular dermal matrix use in expander-implant reconstruction after total skin-sparing mastectomy reduced major postoperative complications in this study. Maximal benefit is achieved with selected use in patients with thin mastectomy skin flaps and those receiving radiation therapy. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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Published In

Plast Reconstr Surg

DOI

EISSN

1529-4242

Publication Date

June 2012

Volume

129

Issue

6

Start / End Page

901e / 908e

Location

United States

Related Subject Headings

  • Tissue Expansion
  • Surgical Flaps
  • Surgery
  • Skin Transplantation
  • Quality Improvement
  • Prospective Studies
  • Postoperative Care
  • Nipples
  • Middle Aged
  • Mastectomy
 

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Peled, A. W., Foster, R. D., Garwood, E. R., Moore, D. H., Ewing, C. A., Alvarado, M., … Esserman, L. J. (2012). The effects of acellular dermal matrix in expander-implant breast reconstruction after total skin-sparing mastectomy: results of a prospective practice improvement study. Plast Reconstr Surg, 129(6), 901e-908e. https://doi.org/10.1097/PRS.0b013e31824ec447
Peled, Anne Warren, Robert D. Foster, Elisabeth R. Garwood, Dan H. Moore, Cheryl A. Ewing, Michael Alvarado, E Shelley Hwang, and Laura J. Esserman. “The effects of acellular dermal matrix in expander-implant breast reconstruction after total skin-sparing mastectomy: results of a prospective practice improvement study.Plast Reconstr Surg 129, no. 6 (June 2012): 901e-908e. https://doi.org/10.1097/PRS.0b013e31824ec447.
Peled AW, Foster RD, Garwood ER, Moore DH, Ewing CA, Alvarado M, et al. The effects of acellular dermal matrix in expander-implant breast reconstruction after total skin-sparing mastectomy: results of a prospective practice improvement study. Plast Reconstr Surg. 2012 Jun;129(6):901e-908e.
Peled, Anne Warren, et al. “The effects of acellular dermal matrix in expander-implant breast reconstruction after total skin-sparing mastectomy: results of a prospective practice improvement study.Plast Reconstr Surg, vol. 129, no. 6, June 2012, pp. 901e-908e. Pubmed, doi:10.1097/PRS.0b013e31824ec447.
Peled AW, Foster RD, Garwood ER, Moore DH, Ewing CA, Alvarado M, Hwang ES, Esserman LJ. The effects of acellular dermal matrix in expander-implant breast reconstruction after total skin-sparing mastectomy: results of a prospective practice improvement study. Plast Reconstr Surg. 2012 Jun;129(6):901e-908e.

Published In

Plast Reconstr Surg

DOI

EISSN

1529-4242

Publication Date

June 2012

Volume

129

Issue

6

Start / End Page

901e / 908e

Location

United States

Related Subject Headings

  • Tissue Expansion
  • Surgical Flaps
  • Surgery
  • Skin Transplantation
  • Quality Improvement
  • Prospective Studies
  • Postoperative Care
  • Nipples
  • Middle Aged
  • Mastectomy