Comparison of Immediate Implant-Based Breast Reconstruction with and without Acellular Dermal Matrix in the Setting of Post-Mastectomy Radiation

INTRODUCTION: Acellular dermal matrix (ADM) is frequently used in tissue expander/implant (TE/I)-based breast reconstruction. There is increasing use of radiation therapy after TE/I breast reconstruction. The purpose of this study was to evaluate the performance profile of ADM in patients with adjuvant radiation therapy after immediate breast reconstruction. METHODS: All patients undergoing TE/I-based immediate breast reconstruction from 2000-2011 at a single academic medical center who underwent adjuvant radiation therapy after reconstruction were evaluated. Autologous flap reconstructions and patients with prior chest wall irradiation were excluded. Direct comparisons were made between ADM and non-ADM cohorts. RESULTS: A total of 67 immediate TE-based breast reconstructions were included [ADM group n=47 (70.1%) non-ADM group n=20 (29.9%)]. Patient characteristics including age at time of reconstruction (mean 48 ±11 vs. 47±10 years) and BMI (mean 24.4±5 vs. 22±3 kg/m2) were similar between groups (P>0.05). In univariate analyses, capsular contracture, inframammary fold (IMF) problems, infection, and wound problems were similar between both groups (P>0.05). After adjusting for clinical characteristics and postoperative complications with multivariate logistic regression, these trends remained. ADM use was not associated with less capsular contracture, IMF problems, wound problems, reoperations, or implant failure requiring flap salvage in the setting of post mastectomy radiation. CONCLUSION: Direct comparison of ADM to non-ADM TE/I based immediate breast reconstruction demonstrates no significant difference between groups in the setting of post-mastectomy radiation. ADM and non-ADM TE/I based immediate breast reconstruction in the setting of post-mastectomy radiation have similar risk profiles. ADM use appears safe in this context. Further work on aesthetic outcome and optimal timing of radiation is warranted.