LAUSR

BACKGROUND Prepectoral tissue expander (TE) placement for two-stage postmastectomy reconstruction is usually performed in conjunction with insertion of acellular dermal matrix (ADM). However, the effects of ADM use on TE loss or other early complications remain unknown. Therefore, the aim of this study was to compare early postoperative complications in patients who underwent prepectoral breast implant reconstruction with or without ADM use. METHODS We performed a retrospective cohort study of all patients at our institution who underwent prepectoral breast reconstruction from January 2018 to June 2021. The primary outcome was TE loss within 90 days of surgery; secondary outcomes included other complications including infection, TE exposure, mastectomy skin flap necrosis requiring revision, and seroma. RESULTS Data on 714 patients with 1,225 TEs (1,060 with ADM, 165 without) were analyzed. Baseline demographics did not differ by ADM use, though mastectomy breast tissue weight was higher in patients without ADM (750.3 g vs. 540.8 g, p < 0.001). Rates of TE loss were similar in reconstructions with (3.8 percent) ADM and without (6.7 percent; p = 0.09). We also did not find differences in the rates of secondary outcomes between cohorts. CONCLUSIONS ADM use had no statistically significant effect on early complication rates among patients undergoing breast reconstruction with prepectoral TEs. Still, we were underpowered and data trended toward statistical significance, so larger studies are required in the future. Additional research and randomized studies should focus on larger cohorts and examine long-term complications such as capsular contracture and implant malposition.