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Four Hundred and Forty Consecutive Immediate Implant-Based Single-Surgeon Breast Reconstructions With Acellular Dermal Matrix: A Comparison of Outcomes and Costs between Surgimend Fetal Bovine and Alloderm Human Cadaveric Matrices
Jennifer L. Butterfield, M.D..
The Christ Hospital, Cincinnati, OH, USA.
Purpose: Respondents to a 2010 nationwide survey of plastic & reconstructive surgeons indicated that ~83% performed predominantly implant-based breast reconstruction, with acellular dermal matrix (ADM) used by about half of those practitioners. While the medical literature documents over 2000 cases of breast reconstruction with ADMs, relatively few cases using other than human cadaveric ADMs have been reported. We report here the second largest series of implant reconstructions with ADM and the largest series utilizing a xenogenic ADM, comparing complications and costs using SurgiMend (SM) fetal bovine and AlloDerm (AD) human cadaveric ADMs.
Methods: Retrospective review of a single surgeon’s five year non-randomized experience was performed for consecutive breast reconstructions with ADM from 2005 - 2010. The study population included 95.0% tissue expander/permanent implant 2-stage and 5.0% direct-to-implant 1-stage patients.
Results: Two hundred eighty one patients had 440 implant-based reconstructions using SurgiMend (222 patients/79.0%) or AlloDerm (59 patients/21.0%) following mastectomy for cancer (197 breasts/56.1% and 51 breasts/57.3%, respectively) or prophylaxis (154 breasts/43.9% and 38 breasts/42.7%, respectively). Bilateral reconstructions accounted for 58.1% breasts and 50.8% breasts reconstructed with SM and AD, respectively (for a representative case, see Figure 1). Patient age and BMI between SM and AD groups were not significantly different, nor were smoking status, hypertension, chemotherapy, radiation therapy, unilateral/bilateral treatment or mastectomy for cancer/prophylaxis. Complication rates were evaluated between ADM/expander placement and exchange to permanent implant for 2-stage procedures and for at least 3 months following ADM placement in 1-stage procedures (Figure 2). No significant differences in complication rates were observed between SM and AD for hematoma, infection or explantation. Seroma was the most prevalent complication, with the rate of seroma for AD (15.7%) significantly greater than that for SM (8.3%) [p < 0.05]. The major necrosis rate, defined as necrosis requiring readmission for tissue excision or explantation, was equivalent for SM and AD, at 2.3% and 2.2% respectively. Hematoma was rare: SM - 1.1%; AD - 0%. Infection rates of SM - 4.8% and AD - 6.7% were within the range of infection rates observed in the literature. Explantation rates were SM - 8.3% and AD - 11.2%. Using current product costs for equivalently-sized AlloDerm and SurgiMend units, the cost of SurgiMend was \ less per breast than AlloDerm
Conclusions: SurgiMend fetal bovine and AlloDerm human cadaveric ADMs demonstrate similar rates of major early complications in breast reconstruction in this non-randomized, single-surgeon study, with the exception of a higher seroma rate for AlloDerm. This similarity in complication rates between SurgiMend and AlloDerm, and SurgiMend’s cost savings potential, are factors for the surgeon to consider in choosing an ADM for breast reconstruction.
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