Trends in Acellular Dermal Matrix Utilization in Postmastectomy Tissue Expander Placement: An 11-Year Retrospective Study.

Abstract

The increasing popularity of acellular dermal matrix (ADM) in alloplastic breast reconstruction has widely influenced reconstruction patterns. This study investigates patterns and clinical outcomes of tissue expander placement with the advent of ADM. Tissue expander cases for breast reconstruction were identified retrospectively within a single academic tertiary referral center from 2013 to 2023. Plane of device placement was classified as subpectoral, dual plane (partial subpectoral with ADM), and prepectoral. The main outcome of interest was ADM usage. Backward stepwise logistic regression was used to assess preoperative predictors of ADM usage and impact of ADM on the likelihood of postoperative infection (P < 0.05). The final cohort included 2019 breasts in 1206 patients. ADM was used in 24.5% of cases. Postoperative infection occurred in 4.3% of cases. In logistic regression, older age (OR: 1.01, 95% CI: 1.00-1.03), lower BMI (OR: 0.97, 95% CI: 0.95-0.98), and preoperative radiation (OR: 1.69, 95% CI: 1.02-2.81) predicted higher odds of ADM utilization, whereas diabetes (OR: 0.61, 95% CI: 0.39-0.96) and neoadjuvant chemotherapy (OR: 0.61, 95% CI: 0.45-0.84) predicted significantly lower odds. In another logistic regression model for overall postoperative infection, older age (OR: 1.02, 95% CI: 1.00-1.04), higher BMI (OR: 1.07, 95% CI: 1.04-1.11), and ADM utilization (OR: 3.66, 95% CI: 2.34-5.73) predicted a significantly higher likelihood of postoperative infection. Our institutional study found that ADM utilization was associated with specific preoperative characteristics and independently predicted a higher likelihood of postoperative infection. Such findings motivate more careful risk stratification for ADM utilization.