PC61. Comparative Postoperative Complications of Acellular Dermal Matrix and Mesh in Prepectoral and Subpectoral One Stage Direct to Implant Reconstruction: A Retrospective Cohort Study

PURPOSE: One-stage direct to implant (DTI) breast reconstruction has become increasingly popular with the use of prepectoral reconstruction. This technique leads to an increased demand for acellular dermal matrix (ADM). It is incumbent on the surgical community to determine if differences in outcomes exist among available products. METHODS: We performed a retrospective cohort study of consecutive patients in our quaternary-care breast cancer center undergoing DTI reconstruction utilizing different matrices. Patient demographics and outcomes extracted through chart review. Outcomes included cellulitis, capsular contracture, hematoma or seroma requiring drainage, skin necrosis, readmission, revisions, and explantation for infection/exposure/capsular contracture. Univariate and multivariate analysis determined differences in outcomes and account for confounding variables. RESULTS:240 consecutive patients (399 breasts) underwent DTI reconstruction. 192 breasts were reconstructed with FlexHD Pliable, 120 AlloDerm, 23 autologous dermal flaps, 21 DermACELL, 21 Galaflex, and 22 Meso BioMatrix. There were no differences in demographics, implant type or size, mastectomy type, or chemoradiation exposure. Univariate analysis demonstrated increased cellulitis (p=0.037), capsular contracture (p=0.008), explantation for capsular contracture (p=0.004), and seroma requiring drainage (p=0.008) with AlloDerm versus the other materials. There were no differences in readmission, explantation for infection/exposure, revisions, skin necrosis, or hematoma incidence. Multivariate regression analysis found no difference in the incidence of cellulitis or seroma of AlloDerm versus other products; however, FlexHD demonstrated a decreased rate of capsular contracture (OR:0.17, p=0.023) and explantation for capsular contracture (OR:0.15, p=0.030) versus AlloDerm. CONCLUSION: While there were no differences in autologus and ADM DTI reconstruction outcomes, certain products have differing safety profiles requiring careful consideration.