Human Acellular Dermis versus Submuscular Tissue Expander Breast Reconstruction: A Multivariate Analysis of Short-Term Complications

Background Acellular dermal matrix (ADM) allografts and their putative benefits have beenincreasingly described in prosthesis based breast reconstruction. There have been a myriadof analyses outlining ADM complication profiles, but few large-scale, multi-institutionalstudies exploring these outcomes. In this study, complication rates of acellular dermis-assistedtissue expander breast reconstruction were compared with traditional submuscular methodsby evaluation of the American College of Surgeon’s National Surgical Quality ImprovementProgram (NSQIP) registry.Methods Patients who underwent immediate tissue expander breast reconstruction from2006-2010 were identified using surgical procedure codes. Two hundred forty tracked variablesfrom over 250 participating sites were extracted for patients undergoing acellular dermisassistedversus submuscular tissue expander reconstruction. Thirty-day postoperative outcomesand captured risk factors for complications were compared between the two groups.Results A total of 9,159 patients underwent tissue expander breast reconstruction; 1,717using acellular dermis and 7,442 with submuscular expander placement. Total complicationsand reconstruction related complications were similar in both cohorts (5.5% vs. 5.3%, P=0.68and 4.7% vs. 4.3%, P=0.39, respectively). Multivariate logistic regression revealed body massindex and smoking as independent risk factors for reconstructive complications in both cohorts(P<0.01).Conclusions The NSQIP database provides large-scale, multi-institutional, independentoutcomes for acellular dermis and submuscular breast reconstruction. Both thirty-daycomplication profiles and risk factors for post operative morbidity are similar between thesetwo reconstructive approaches.