Comparison of Implant-Based Immediate Breast Reconstruction with and without Acellular Dermal Matrix

Background: Acellular dermal matrix is frequently used in implant-based breast reconstruction to cover the inferior aspect of the breast pocket. Its performance profile remains equivocal. The authors studied whether adding it in implant-based immediate breast reconstruction improved outcomes when compared with non-acellular dermal matrix reconstruction. Methods: Patients undergoing implant-based immediate breast reconstruction at a single academic medical center were evaluated. Aesthetic outcomes and postoperative complications were assessed and direct comparisons were made between acellular dermal matrix and non-acellular dermal matrix cohorts. Results: A total of 203 patients underwent 337 immediate expander-based breast reconstructions [with acellular dermal matrix, n = 208 (61.7 percent); without, n = 129 (38.3 percent)]. Patient characteristics, including age at time of reconstruction (mean, 49 +/- 11 versus 47 +/- 10 years) and body mass index (mean, 23 +/- 5 versus 23 +/- 3 kg/m(2)) were similar between groups (p > 0.05). Complications occurred in one-third of patients (33.5 percent). In univariate analyses, acellular dermal matrix use had fewer overall complications (odds ratio, 0.61; 95 percent CI, 0.38 to 0.97). The incidences of seroma/hematoma (p = 0.59), infection (p = 0.31), and wound complications (p = 0.26) did not differ. Aesthetic outcomes were higher in the acellular dermal matrix group. In multivariate logistic regression, acellular dermal matrix use was associated with less capsular contracture (odds ratio, 0.18; 95 percent CI, 0.08 to 0.43) and mechanical shift (odds ratio, 0.23; 95 percent CI, 0.06 to 0.78). Conclusions: Optimizing the inframammary fold with acellular dermal matrix creates a superior aesthetic result. Its use appears safe and is associated with less capsular contracture and mechanical shift and improvement in the inframammary fold appearance, without increasing postoperative complications. (Plast. Reconstr. Surg. 128: 403e, 2011.)