The Use of Acellular Dermal Matrix May Not Increase 30-Day Complications in Direct-to-Implant Breast Reconstruction: A Multi-institutional Analysis of 10,177 Cases.

BACKGROUND

Direct-to-implant (DTI) breast reconstruction offers immediate aesthetic and psychological benefits, but the role of acellular dermal matrix (ADM) remains debated. Using a multi-institutional database, this study evaluates and compares outcomes between ADM-assisted and non-ADM DTI procedures.

METHODS

The American College of Surgeons National Surgical Quality Improvement Program database from 2008 to 2022 was queried to identify female patients who underwent DTI breast reconstruction for oncological purposes. Patients were divided into 2 groups: DTI breast reconstruction with ADM and without. Thirty-day postoperative complications were compared using multivariate analysis and propensity score matching.

RESULTS

Among 10,177 patients, 45% (n = 4605) underwent ADM-assisted DTI, while 55% (n = 5572) had non-ADM DTI. While both groups showed comparable mean ages (ADM: 52 ± 12 years vs non-ADM: 51 ± 11 years; P = 0.190), ADM patients were significantly less likely to present with comorbidities such as obesity (ADM: 21.5% vs non-ADM: 26%; P < 0.001), hypertension (20.5% vs 2.6%; P = 0.01), diabetes (4.8% vs 5.1%; P = 0.002), and smoking history (6.4% vs 10.1%; P < 0.001). Still, surgical complication rates were comparable (ADM: 4.7%, non-ADM: 5.5%; P = 0.08), including superficial infections (2.0% vs 2.4%; P = 0.19), deep infections (0.6% vs 0.9%; P = 0.17), wound dehiscence (0.8% vs 1.0%; P = 0.24), and bleeding (0.6% vs 0.7%; P = 0.54). Medical complications were generally rare and also showed no significant differences (ADM: 1.4%, non-ADM: 1.7%; P = 0.27). Confounder-adjusted multivariable analysis and propensity score matching confirmed no increased risk of surgical (odds ratio 0.93, 95% confidence interval 0.75-1.16, P = 0.52) or medical complications (odds ratio 0.87, 95% confidence interval 0.59-1.26, P = 0.46).

CONCLUSIONS

The use of ADM in DTI breast reconstruction is not associated with a higher risk of short-term complications, supporting its continued use in clinical practice. This information is crucial for surgeons and patients in making informed decisions regarding the incorporation of ADM in DTI breast reconstruction.