Acellular dermal matrix in direct-to-implant breast reconstruction: univariate and multivariate analysis on potential risk factors

Background: Acellular dermal matrices (ADM) are widely used in direct-to-implant breast reconstruction and were introduced as part of the implant-based breast reconstruction within the previous decade. This study presents clinical outcomes of ADM-assisted direct-to-implant breast reconstruction and evaluates the most frequent and severe postoperative complications. Methods: We performed a retrospective analysis of patients who underwent ADM-assisted submuscular direct-to-implant breast reconstruction from March 2013 to February 2017 at the University Hospital Copenhagen, Rigshospitalet. All postoperative complications were classified using the Clavien Dindo classification of surgical complications. We used univariate and multivariate analyses with Fisher’s exact test and multiple logistic regression to determine potential risk factors. Results: A total of 102 breast reconstructions were carried out in the inclusion period. The incidence rate of severe skin flap necrosis and surgical site infection was 6% and 4%, respectively. The total rate of skin flap necrosis was 14.7%, surgical site infection 11.8%, rotation of anatomical implants 4.90%, seroma 3.92%, dynamic breast deformity 1.96% and hematoma 1.96%. No patients suffered from red breast syndrome or capsular contracture. Total explantation rate was 4.90%. The median follow-up period was 32 months. Conclusion: This study demonstrates an acceptable rate of explantation in ADM-assisted direct-to-implant breast reconstruction. We found that skin flap necrosis and surgical site infection were the most frequently occurring complications with low rates of severe cases. However, there is a need for larger, controlled studies to further explore the impact of patient and surgery related risk factors. Level of evidence: Level III, Risk/Prognostic.