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 im...
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| Veröffentlicht in: | Aesthetic surgery journal 2019-02, Vol.39 (3), p.279-288 |
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| container_title | Aesthetic surgery journal |
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| creator | Craig, Elizabeth S Clemens, Mark W Koshy, John C Wren, James Hong, Zhang Butler, Charles E Garvey, Patrick B Selber, Jesse C Kronowitz, Steven J |
| description | 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 |
| doi_str_mv | 10.1093/asj/sjy127 |
| format | Article |
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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</description><identifier>ISSN: 1090-820X</identifier><identifier>EISSN: 1527-330X</identifier><identifier>DOI: 10.1093/asj/sjy127</identifier><identifier>PMID: 29800083</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Acellular Dermis - metabolism ; Adult ; Aged ; Breast Implantation - methods ; Breast Neoplasms - radiotherapy ; Breast Neoplasms - surgery ; Cohort Studies ; Device Removal ; Female ; Follow-Up Studies ; Humans ; Mammaplasty - methods ; Mastectomy - methods ; Middle Aged ; Postoperative Complications - epidemiology ; Retrospective Studies ; Tissue Expansion - methods ; Tissue Expansion Devices</subject><ispartof>Aesthetic surgery journal, 2019-02, Vol.39 (3), p.279-288</ispartof><rights>2018 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com 2018</rights><rights>2018 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c394t-50def54f79f1f6b3d7eaccf7848904fac3515440685d2fc04846e0bf8b9a65e83</citedby><cites>FETCH-LOGICAL-c394t-50def54f79f1f6b3d7eaccf7848904fac3515440685d2fc04846e0bf8b9a65e83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,1584,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29800083$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Craig, Elizabeth S</creatorcontrib><creatorcontrib>Clemens, Mark W</creatorcontrib><creatorcontrib>Koshy, John C</creatorcontrib><creatorcontrib>Wren, James</creatorcontrib><creatorcontrib>Hong, Zhang</creatorcontrib><creatorcontrib>Butler, Charles E</creatorcontrib><creatorcontrib>Garvey, Patrick B</creatorcontrib><creatorcontrib>Selber, Jesse C</creatorcontrib><creatorcontrib>Kronowitz, Steven J</creatorcontrib><title>Outcomes of Acellular Dermal Matrix for Immediate Tissue Expander Reconstruction with Radiotherapy: A Retrospective Cohort Study</title><title>Aesthetic surgery journal</title><addtitle>Aesthet Surg J</addtitle><description>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</description><subject>Acellular Dermis - metabolism</subject><subject>Adult</subject><subject>Aged</subject><subject>Breast Implantation - methods</subject><subject>Breast Neoplasms - radiotherapy</subject><subject>Breast Neoplasms - surgery</subject><subject>Cohort Studies</subject><subject>Device Removal</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Mammaplasty - methods</subject><subject>Mastectomy - methods</subject><subject>Middle Aged</subject><subject>Postoperative Complications - epidemiology</subject><subject>Retrospective Studies</subject><subject>Tissue Expansion - methods</subject><subject>Tissue Expansion Devices</subject><issn>1090-820X</issn><issn>1527-330X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1Lw0AQhhdRbP24-ANkL4II0U12k2y8lVq1UBFqBW9hu5mlKUk37oe2N3-6W6oePc0MPPMy8yB0FpPrmBT0RtjljV1u4iTfQ_04TfKIUvK2H3pSkIgn5K2HjqxdEhLojB2iXlLwMHDaR1_P3kndgsVa4YGEpvGNMPgOTCsa_CScqddYaYPHbQtVLRzgWW2tBzxad2JVgcFTkHplnfHS1XqFP2u3wFNR1dotwIhuc4sHgXFG2w4C8gF4qBfaOPzifLU5QQdKNBZOf-oxer0fzYaP0eT5YTwcTCJJC-ailFSgUqbyQsUqm9MqByGlyjnjBWFKSJrGKWMk42mVKEkYZxmQueLzQmQpcHqMLne5ndHvHqwr29pu_xUr0N6WCWEpDeu0COjVDpXhZmtAlZ2pW2E2ZUzKrfEyGC93xgN8_pPr58HQH_qrOAAXO0D77r-gb1MyjIE</recordid><startdate>20190215</startdate><enddate>20190215</enddate><creator>Craig, Elizabeth S</creator><creator>Clemens, Mark W</creator><creator>Koshy, John C</creator><creator>Wren, James</creator><creator>Hong, Zhang</creator><creator>Butler, Charles E</creator><creator>Garvey, Patrick B</creator><creator>Selber, Jesse C</creator><creator>Kronowitz, Steven J</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20190215</creationdate><title>Outcomes of Acellular Dermal Matrix for Immediate Tissue Expander Reconstruction with Radiotherapy: A Retrospective Cohort Study</title><author>Craig, Elizabeth S ; Clemens, Mark W ; Koshy, John C ; Wren, James ; Hong, Zhang ; Butler, Charles E ; Garvey, Patrick B ; Selber, Jesse C ; Kronowitz, Steven J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c394t-50def54f79f1f6b3d7eaccf7848904fac3515440685d2fc04846e0bf8b9a65e83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Acellular Dermis - metabolism</topic><topic>Adult</topic><topic>Aged</topic><topic>Breast Implantation - methods</topic><topic>Breast Neoplasms - radiotherapy</topic><topic>Breast Neoplasms - surgery</topic><topic>Cohort Studies</topic><topic>Device Removal</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Mammaplasty - methods</topic><topic>Mastectomy - methods</topic><topic>Middle Aged</topic><topic>Postoperative Complications - epidemiology</topic><topic>Retrospective Studies</topic><topic>Tissue Expansion - methods</topic><topic>Tissue Expansion Devices</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Craig, Elizabeth S</creatorcontrib><creatorcontrib>Clemens, Mark W</creatorcontrib><creatorcontrib>Koshy, John C</creatorcontrib><creatorcontrib>Wren, James</creatorcontrib><creatorcontrib>Hong, Zhang</creatorcontrib><creatorcontrib>Butler, Charles E</creatorcontrib><creatorcontrib>Garvey, Patrick B</creatorcontrib><creatorcontrib>Selber, Jesse C</creatorcontrib><creatorcontrib>Kronowitz, Steven J</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Aesthetic surgery journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Craig, Elizabeth S</au><au>Clemens, Mark W</au><au>Koshy, John C</au><au>Wren, James</au><au>Hong, Zhang</au><au>Butler, Charles E</au><au>Garvey, Patrick B</au><au>Selber, Jesse C</au><au>Kronowitz, Steven J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes of Acellular Dermal Matrix for Immediate Tissue Expander Reconstruction with Radiotherapy: A Retrospective Cohort Study</atitle><jtitle>Aesthetic surgery journal</jtitle><addtitle>Aesthet Surg J</addtitle><date>2019-02-15</date><risdate>2019</risdate><volume>39</volume><issue>3</issue><spage>279</spage><epage>288</epage><pages>279-288</pages><issn>1090-820X</issn><eissn>1527-330X</eissn><abstract>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</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>29800083</pmid><doi>10.1093/asj/sjy127</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Aesthetic surgery journal, 2019-02, Vol.39 (3), p.279-288 |
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| language | eng |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection |
| subjects | Acellular Dermis - metabolism Adult Aged Breast Implantation - methods Breast Neoplasms - radiotherapy Breast Neoplasms - surgery Cohort Studies Device Removal Female Follow-Up Studies Humans Mammaplasty - methods Mastectomy - methods Middle Aged Postoperative Complications - epidemiology Retrospective Studies Tissue Expansion - methods Tissue Expansion Devices |
| title | Outcomes of Acellular Dermal Matrix for Immediate Tissue Expander Reconstruction with Radiotherapy: A Retrospective Cohort Study |
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