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Outcomes Using a Macro-Fenestrated Acellular Dermal Matrix in Direct-to-Implant Breast Reconstruction
Oliver, Claire, MD; Leberfinger, Ashley, MD; Vaidya, Abhishek, DO; Cody, Derek, MD
Summa Health System
2024-02-01
Presenter: Claire Oliver
Affidavit:
This project is the original work of the listed residents.
Director Name: Ananth Murthy, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background: Acellular dermal matrix (ADM) is a broadly accepted adjunct in implant-based breast reconstruction. Its use facilitates implant placement, permits increased intraoperative pocket fill, and is associated with decreased rates of capsular contracture and improved aesthetic outcomes. Despite these potential benefits, ADM may confer an elevated seroma risk and therefore the possibility for negative seroma-related reconstruction outcomes. ADM fenestration has been proposed as one strategy to mitigate seroma formation. Here we present a technique of ADM macro-fenestration and its outcomes in direct-to-implant (DTI) breast reconstruction.
Methods: This is a retrospective cohort study of patients who underwent DTI breast reconstruction with ADM at a single institution over a two year period. Patients underwent reconstruction with placement of either macro-fenestrated or unaltered ADM. Charts were reviewed for post-operative rates of seroma development. Indication for the mastectomy and patient comorbidities were evaluated. Secondary variables including infection, secondary procedures for seroma evacuation, and implant loss associated with fluid collection were also investigated.
Results: A total of 315 breasts in 204 patients who underwent DTI breast reconstruction were included. Of these, 81 breasts received reconstructions using a fenestrated ADM and 234 with un-fenestrated ADM. Fenestration had a lower risk of seroma at 9.8% compared to 18% in the un-fenestrated group, resulting in the need for fewer drainage procedures. Both groups had comparable rates of infection and implant loss.
Conclusion: This study supports ADM fenestration as a useful technique for seroma reduction in DTI breast reconstruction.
