The BREASTrial: Stage I. outcomes from the time of tissue expander and acellular dermal matrix placement to definitive reconstruction

Shaun D. Mendenhall, Layla A. Anderson, Jian Ying, Kenneth M. Boucher, Ting Liu, Leigh A Neumayer, Jayant P. Agarwal

Research output: Contribution to journalArticle

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Abstract

Background: Use of acellular dermal matrix in tissue expander breast reconstruction has become a popular adjunct to the total submuscular technique. The question remains as to which matrix, if any, is ideal for breast reconstruction. Methods: A randomized trial was conducted to analyze outcomes of immediate staged tissue expander breast reconstruction using either AlloDerm or Derma- Matrix. The impact of obesity, radiation, and chemotherapy on complications and biointegration of matrix was investigated. The trial was divided into three stages, with stage I results reported here. Results: One hundred twenty-eight patients (199 breasts) were randomized equally over 2.5 years. Most patients were white, healthy nonsmokers. The overall complication rate was 36.2 percent; half of the complications were minor. The AlloDerm and DermaMatrix groups had similar rates of complications (33.6 percent versus 38.8 percent; p = 0.52), consisting mostly of skin necrosis (17.8 percent versus 21.4 percent; p = 0.66) and infections (13.9 percent versus 16.3 percent; p = 0.29), both of which led to tissue expander losses (5 percent versus 11.2 percent; p = 0.11). The AlloDerm group required less time for completion of expansion (42 days versus 70 days; p < 0.001). Obesity was associated with poor matrix biointegration and a longer drain time, both of which were associated with higher complication rates. Conclusion: The Breast Reconstruction Evaluation Using Acellular Dermal Matrix as a Sling Trial is the largest randomized trial to date in matrix breast reconstruction and emphasizes the importance of careful patient and allograft selection to minimize complications.

Original languageEnglish (US)
Pages (from-to)29e-42e
JournalPlastic and Reconstructive Surgery
Volume135
Issue number1
DOIs
StatePublished - 2015
Externally publishedYes

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Acellular Dermis
Tissue Expansion Devices
Mammaplasty
Obesity
Patient Selection
Allografts
Breast
Necrosis
Radiation
Drug Therapy
Skin
Infection
Alloderm

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

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The BREASTrial : Stage I. outcomes from the time of tissue expander and acellular dermal matrix placement to definitive reconstruction. / Mendenhall, Shaun D.; Anderson, Layla A.; Ying, Jian; Boucher, Kenneth M.; Liu, Ting; Neumayer, Leigh A; Agarwal, Jayant P.

In: Plastic and Reconstructive Surgery, Vol. 135, No. 1, 2015, p. 29e-42e.

Research output: Contribution to journalArticle

Mendenhall, Shaun D. ; Anderson, Layla A. ; Ying, Jian ; Boucher, Kenneth M. ; Liu, Ting ; Neumayer, Leigh A ; Agarwal, Jayant P. / The BREASTrial : Stage I. outcomes from the time of tissue expander and acellular dermal matrix placement to definitive reconstruction. In: Plastic and Reconstructive Surgery. 2015 ; Vol. 135, No. 1. pp. 29e-42e.
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abstract = "Background: Use of acellular dermal matrix in tissue expander breast reconstruction has become a popular adjunct to the total submuscular technique. The question remains as to which matrix, if any, is ideal for breast reconstruction. Methods: A randomized trial was conducted to analyze outcomes of immediate staged tissue expander breast reconstruction using either AlloDerm or Derma- Matrix. The impact of obesity, radiation, and chemotherapy on complications and biointegration of matrix was investigated. The trial was divided into three stages, with stage I results reported here. Results: One hundred twenty-eight patients (199 breasts) were randomized equally over 2.5 years. Most patients were white, healthy nonsmokers. The overall complication rate was 36.2 percent; half of the complications were minor. The AlloDerm and DermaMatrix groups had similar rates of complications (33.6 percent versus 38.8 percent; p = 0.52), consisting mostly of skin necrosis (17.8 percent versus 21.4 percent; p = 0.66) and infections (13.9 percent versus 16.3 percent; p = 0.29), both of which led to tissue expander losses (5 percent versus 11.2 percent; p = 0.11). The AlloDerm group required less time for completion of expansion (42 days versus 70 days; p < 0.001). Obesity was associated with poor matrix biointegration and a longer drain time, both of which were associated with higher complication rates. Conclusion: The Breast Reconstruction Evaluation Using Acellular Dermal Matrix as a Sling Trial is the largest randomized trial to date in matrix breast reconstruction and emphasizes the importance of careful patient and allograft selection to minimize complications.",
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