Abstract 64: Developing an Evidence-Based Approach to Using Acellular Dermal Matrix in Expander-Implant-based Breast Reconstruction

PURPOSE: Although acellular dermal matrix (ADM) is widely used in expander-implant (E/I) breast reconstructions, previous analyses have been unable to demonstrate improvements in patient-reported outcomes (PROs) with this approach over non-ADM E/I procedures. Attempting to develop a more selective, evidence-based approach to the use of ADM, we sought to identify patient subgroups in which ADM improved outcomes for E/I reconstruction. METHODS: The Mastectomy Reconstruction Outcomes Consortium (MROC) Study prospectively evaluated immediate E/I reconstructions at 11 centers from 2012 to 2015. Complications (total and major), and PROs (satisfaction, physical, psychosocial and sexual well-being) were assessed two years postoperatively using medical records and the BREAST-Q, respectively. Using mixed-models accounting for centers and with interaction terms, we analyzed for differential ADM effects across various clinical subgroups, including age categories, BMI categories, radiation timing, and chemotherapy. RESULTS: Expander/implant reconstruction was performed in 1451 patients, 738 with and 713 without ADM. Major complication risk was higher in ADM users vs. non-users (22.9% vs. 16.4%, p=0.04). Major complication risks with ADM increased with higher BMI (p=0.02; BMI=30, OR=1.54; BMI=35, OR=2.07). No significant ADM effects were observed on breast satisfaction, psychosocial, sexual and physical well-being within any subgroups. CONCLUSION: In immediate Expander/Implant reconstruction, ADM was associated with greater risk of major complications, particularly in high-BMI patients. We were unable to identify any patient subgroups where ADM use was associated with significant improvements in patient-reported outcomes. Given these findings and the attendant costs of ADM, a more critical approach to the use of ADM may be warranted.