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Does Acellular Dermal Matrix Really Improve Aesthetic Outcome in Tissue Expander/Implant-Based Breast Reconstruction?

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Abstract

Background

The expectation for improved results by women undergoing postmastectomy reconstruction has steadily risen. A majority of these operations are tissue expander/implant-based breast reconstructions. Acellular dermal matrix (ADM) offers numerous advantages in these procedures. Thus far, the evidence to justify improved aesthetic outcome has solely been based on surgeon opinion. The purpose of this study was to assess aesthetic outcome following ADM use in tissue expander/implant-based breast reconstruction by a panel of blinded plastic surgeons.

Methods

Mean aesthetic results of patients who underwent tissue expander/implant-based breast reconstruction with (n = 18) or without ADM (n = 20) were assessed with objective grading of preoperative and postoperative photographs by five independent blinded plastic surgeons. Absolute observed agreement as well as weighted Fleiss Kappa (κ) test statistics were calculated to assess inter-rater variability.

Results

When ADM was incorporated, the overall aesthetic score was improved by an average of 12.1 %. In addition, subscale analyses revealed improvements in breast contour (35.2 %), implant placement (20.7 %), lower pole projection (16.7 %), and inframammary fold definition (13.8 %). Contour (p = 0.039), implant placement (p = 0.021), and overall aesthetic score (p = 0.022) reached statistical significance. Inter-rater reliability showed mostly moderate agreement.

Conclusions

Mean aesthetic scores were higher in the ADM-assisted breast reconstruction cohort including the total aesthetic score which was statistically significant. Aesthetic outcome alone may justify the added expense of incorporating biologic mesh. Moreover, ADM has other benefits which may render it cost-effective. Larger prospective studies are needed to provide plastic surgeons with more definitive guidelines for ADM use.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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Acknowledgements

The authors would like to thank Danielle J. Chuang, Chen Zheng, Sameh F. Goubran, Tarek M. Hassouna, and Kuylhee Kim for their assistance in helping to put this study together.

Conflict of interest

None of the authors have a financial interest in any of the products, devices, drugs or procedures mentioned in this manuscript. There was no internal or external financial support for this study.

Ethical Approval

This study was approved by the Institutional Review Board at the Beth Israel Deaconess Medical Center.

Author information

Authors and Affiliations

  1. Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Ahmed M. S. Ibrahim, Pieter G. L. Koolen, Oren Ganor, Mark K. Markarian, Adam M. Tobias, Bernard T. Lee & Samuel J. Lin

  2. Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, P.O. Box 2040, NL-3000 CA, Rotterdam, The Netherlands

    Marc A. M. Mureau

Authors
  1. Ahmed M. S. Ibrahim
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  2. Pieter G. L. Koolen
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  3. Oren Ganor
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  4. Mark K. Markarian
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  5. Adam M. Tobias
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  6. Bernard T. Lee
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  7. Samuel J. Lin
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  8. Marc A. M. Mureau
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Corresponding author

Correspondence to Marc A. M. Mureau.

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Ibrahim, A.M.S., Koolen, P.G.L., Ganor, O. et al. Does Acellular Dermal Matrix Really Improve Aesthetic Outcome in Tissue Expander/Implant-Based Breast Reconstruction?. Aesth Plast Surg 39, 359–368 (2015). https://doi.org/10.1007/s00266-015-0484-x

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  • DOI: https://doi.org/10.1007/s00266-015-0484-x

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