Use of acellular cadaveric dermis and tissue expansion in postmastectomy breast reconstruction

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Summary

Tissue expander or permanent implant coverage in postmastectomy breast reconstruction is often challenging. Multiple authors have demonstrated the use of acellular cadaveric dermis (ACD) in nonexpansive, single-stage breast reconstruction. The literature also suggests that tissue expansion may be accomplished with ACD as well for stage reconstructions. In many cases tissue expansion is necessary to create a submuscular and subACD pocket to accommodate a subsequent permanent prosthesis. In this study we report the outcomes and complication rates of using ACD in staged breast reconstruction. We reviewed the charts of 41 patients (65 breasts) in whom ACD was used in staged reconstructions. We analysed the patients' charts and operative records to determine postoperative complication rates and results. Complication rates for wound infection, expander removal, haematoma, and seroma were: 3.1% (two of 65), 1.5% (one of 65), 1.5% (one of 65), and 4.6% (three of 65), respectively. The use of ACD in expansive postmastectomy breast reconstruction has an extremely low complication rate, results in good cosmetic outcome, and should be in the repertoire of plastic surgeons. Further follow up is needed to evaluate the long term outcomes of ACD use in postmastectomy breast reconstruction.

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Patients and methods

We performed a retrospective chart review of all patients who underwent staged tissue expansive breast reconstruction at two institutions between July 2004 and July 2005 performed by our two senior authors, DJL and DAK. Our patient population includes 41 patients for a total of 65 breast reconstructions that used ACD for tissue expander coverage (and subsequent implant coverage). We analysed these charts with particular emphasis on determining rates of postoperative complications inclusive of

Results

Among the 41 patient (65 breasts), 24 underwent bilateral reconstructions and the remaining 17 underwent unilateral reconstruction. All cases were performed immediately after the general surgeon completed each mastectomy. Forty-seven of 65 breasts had expander exchange with silicone permanent implant and 18 with saline. Patients expected to require radiation postoperatively were not recommended to undergo implant-based reconstruction because of poor results reported by others.13, 14 However

Discussion

In our case series, the rate of wound infection was minimal (Table 1). In only one case, the ACD and tissue expander were removed due to a deep wound infection. However, this occurred in a patient who underwent radiation therapy to that breast. Her infection resolved after removal of the prosthesis and a short course of i.v. antibiotics. She is currently in the preoperative planning stage for an autologous flap reconstruction.

In our series the rate of major complications with postoperative

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