Outcomes of acellular dermal matrix for immediate tissue expander reconstruction with radiotherapy: A retrospective cohort study

Elizabeth S. Craig, Mark Warren Clemens, John C. Koshy, James Wren, Hong Zhang, Charles E Butler, Patrick Bryan Garvey, Jesse Creed Selber, Steven J. Kronowitz

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Abstract

Background Despite increasing literature support for the use of acellular dermal matrix (ADM) in expander-based breast reconstruction, the effect of ADM on clinical outcomes in the presence of post-mastectomy radiation therapy (PMRT) has not been well described. Objectives To analyze the impact ADM plays on clinical outcomes on immediate tissue expander (ITE) reconstruction undergoing PMRT. Methods We retrospectively reviewed patients who underwent ITE breast reconstruction from 2004 to 2014 at MD Anderson Cancer Center. Patients were categorized into four cohorts: ADM, ADM with PMRT, non-ADM, and non-ADM with PMRT. Outcomes and complications were compared among cohorts. Results Over 10 years, 957 patients underwent ITE reconstruction (683 non-ADM, 113 non-ADM with PMRT, 486 ADM, and 88 ADM with PMRT) with 1370 reconstructions. Overall complication rates for the ADM and non-ADM cohorts were 39.0% and 16.7%, respectively (P < 0.001). Within both cohorts, mastectomy skin flap necrosis (MSFN) was the most common complication, followed by infection. ADM use was associated with a significantly higher rate of infections and seromas in both radiated and non-radiated groups; however, when comparing radiated cohorts, the incidence of explantation was significantly lower with the use of ADM. Conclusions The decision to use ADM for expander-based breast reconstruction should be performed with caution, given higher overall rates of complications, including infections and seromas. There may, however, be a role for ADM in cases requiring PMRT, as the overall incidence of implant failure is lower than non-ADM cases. Level of Evidence: 3

Original languageEnglish (US)
Pages (from-to)279-288
Number of pages10
JournalAesthetic surgery journal
Volume39
Issue number3
DOIs
StatePublished - Feb 15 2019

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Acellular Dermis
Tissue Expansion Devices
Cohort Studies
Radiotherapy
Retrospective Studies
Mastectomy
Mammaplasty
Skin
Seroma
Infection
Incidence

ASJC Scopus subject areas

  • Surgery

Cite this

Outcomes of acellular dermal matrix for immediate tissue expander reconstruction with radiotherapy : A retrospective cohort study. / Craig, Elizabeth S.; Clemens, Mark Warren; Koshy, John C.; Wren, James; Zhang, Hong; Butler, Charles E; Garvey, Patrick Bryan; Selber, Jesse Creed; Kronowitz, Steven J.

In: Aesthetic surgery journal, Vol. 39, No. 3, 15.02.2019, p. 279-288.

Research output: Contribution to journalArticle

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title = "Outcomes of acellular dermal matrix for immediate tissue expander reconstruction with radiotherapy: A retrospective cohort study",
abstract = "Background Despite increasing literature support for the use of acellular dermal matrix (ADM) in expander-based breast reconstruction, the effect of ADM on clinical outcomes in the presence of post-mastectomy radiation therapy (PMRT) has not been well described. Objectives To analyze the impact ADM plays on clinical outcomes on immediate tissue expander (ITE) reconstruction undergoing PMRT. Methods We retrospectively reviewed patients who underwent ITE breast reconstruction from 2004 to 2014 at MD Anderson Cancer Center. Patients were categorized into four cohorts: ADM, ADM with PMRT, non-ADM, and non-ADM with PMRT. Outcomes and complications were compared among cohorts. Results Over 10 years, 957 patients underwent ITE reconstruction (683 non-ADM, 113 non-ADM with PMRT, 486 ADM, and 88 ADM with PMRT) with 1370 reconstructions. Overall complication rates for the ADM and non-ADM cohorts were 39.0{\%} and 16.7{\%}, respectively (P < 0.001). Within both cohorts, mastectomy skin flap necrosis (MSFN) was the most common complication, followed by infection. ADM use was associated with a significantly higher rate of infections and seromas in both radiated and non-radiated groups; however, when comparing radiated cohorts, the incidence of explantation was significantly lower with the use of ADM. Conclusions The decision to use ADM for expander-based breast reconstruction should be performed with caution, given higher overall rates of complications, including infections and seromas. There may, however, be a role for ADM in cases requiring PMRT, as the overall incidence of implant failure is lower than non-ADM cases. Level of Evidence: 3",
author = "Craig, {Elizabeth S.} and Clemens, {Mark Warren} and Koshy, {John C.} and James Wren and Hong Zhang and Butler, {Charles E} and Garvey, {Patrick Bryan} and Selber, {Jesse Creed} and Kronowitz, {Steven J.}",
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T1 - Outcomes of acellular dermal matrix for immediate tissue expander reconstruction with radiotherapy

T2 - A retrospective cohort study

AU - Craig, Elizabeth S.

AU - Clemens, Mark Warren

AU - Koshy, John C.

AU - Wren, James

AU - Zhang, Hong

AU - Butler, Charles E

AU - Garvey, Patrick Bryan

AU - Selber, Jesse Creed

AU - Kronowitz, Steven J.

PY - 2019/2/15

Y1 - 2019/2/15

N2 - Background Despite increasing literature support for the use of acellular dermal matrix (ADM) in expander-based breast reconstruction, the effect of ADM on clinical outcomes in the presence of post-mastectomy radiation therapy (PMRT) has not been well described. Objectives To analyze the impact ADM plays on clinical outcomes on immediate tissue expander (ITE) reconstruction undergoing PMRT. Methods We retrospectively reviewed patients who underwent ITE breast reconstruction from 2004 to 2014 at MD Anderson Cancer Center. Patients were categorized into four cohorts: ADM, ADM with PMRT, non-ADM, and non-ADM with PMRT. Outcomes and complications were compared among cohorts. Results Over 10 years, 957 patients underwent ITE reconstruction (683 non-ADM, 113 non-ADM with PMRT, 486 ADM, and 88 ADM with PMRT) with 1370 reconstructions. Overall complication rates for the ADM and non-ADM cohorts were 39.0% and 16.7%, respectively (P < 0.001). Within both cohorts, mastectomy skin flap necrosis (MSFN) was the most common complication, followed by infection. ADM use was associated with a significantly higher rate of infections and seromas in both radiated and non-radiated groups; however, when comparing radiated cohorts, the incidence of explantation was significantly lower with the use of ADM. Conclusions The decision to use ADM for expander-based breast reconstruction should be performed with caution, given higher overall rates of complications, including infections and seromas. There may, however, be a role for ADM in cases requiring PMRT, as the overall incidence of implant failure is lower than non-ADM cases. Level of Evidence: 3

AB - Background Despite increasing literature support for the use of acellular dermal matrix (ADM) in expander-based breast reconstruction, the effect of ADM on clinical outcomes in the presence of post-mastectomy radiation therapy (PMRT) has not been well described. Objectives To analyze the impact ADM plays on clinical outcomes on immediate tissue expander (ITE) reconstruction undergoing PMRT. Methods We retrospectively reviewed patients who underwent ITE breast reconstruction from 2004 to 2014 at MD Anderson Cancer Center. Patients were categorized into four cohorts: ADM, ADM with PMRT, non-ADM, and non-ADM with PMRT. Outcomes and complications were compared among cohorts. Results Over 10 years, 957 patients underwent ITE reconstruction (683 non-ADM, 113 non-ADM with PMRT, 486 ADM, and 88 ADM with PMRT) with 1370 reconstructions. Overall complication rates for the ADM and non-ADM cohorts were 39.0% and 16.7%, respectively (P < 0.001). Within both cohorts, mastectomy skin flap necrosis (MSFN) was the most common complication, followed by infection. ADM use was associated with a significantly higher rate of infections and seromas in both radiated and non-radiated groups; however, when comparing radiated cohorts, the incidence of explantation was significantly lower with the use of ADM. Conclusions The decision to use ADM for expander-based breast reconstruction should be performed with caution, given higher overall rates of complications, including infections and seromas. There may, however, be a role for ADM in cases requiring PMRT, as the overall incidence of implant failure is lower than non-ADM cases. Level of Evidence: 3

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U2 - 10.1093/asj/sjy127

DO - 10.1093/asj/sjy127

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