Acellular Dermal Matrix in Immediate Expander/Implant Breast Reconstruction: A Multicenter Assessment of Risks and Benefits.

INTRODUCTION: Acellular dermal matrix (ADM) has gained widespread acceptance in immediate expander/implant reconstruction due to perceived benefits, including improved expansion dynamics and superior aesthetic results. Although previous investigators have evaluated its risks, few studies have assessed the impact of ADM on other outcomes, including patient-reported measures. METHODS: The Mastectomy Reconstruction Outcomes Consortium (MROC) Study used a prospective cohort design to evaluate patients undergoing post-mastectomy reconstruction from 10 centers and 58 participating surgeons between 2012 and 2015. The analysis focused on women receiving immediate tissue expander reconstruction following mastectomies for cancer treatment or prophylaxis. Medical records and PRO data, using the BREAST-Q and Numeric Pain Rating Scale (NPRS) instruments, were reviewed. Bivariate analyses and mixed-effects regression models were applied. RESULTS: A total of 1,297 patients were evaluated, including 655 (50.5%) with ADM and 642 (49.5%) without ADM. Controlling for demographic and clinical covariates, no significant differences were seen between ADM and non-ADM cohorts in overall complications (OR=1.21, p=0.263), major complications (OR=1.43, p=0.052), wound infections (OR=1.49, p=0.118), or reconstructive failures (OR=1.55, p=0.089) at two years following reconstruction. There were also no significant differences between the cohorts in the time to expander/implant exchange (p=0.78). No significant differences were observed in PRO scores, including satisfaction with breast, psychosocial well-being, sexual well-being, physical well-being and postoperative pain. CONCLUSION: In our multicenter, prospective analysis, we found no significant ADM effects on complications, time to exchange or PRO in immediate expander/implant breast reconstruction. Further studies are needed to develop criteria for more selective use of ADM in these patients. (C)2017American Society of Plastic Surgeons

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