Use of partial acellular dermal matrix in prepectoral nipple-sparing mastectomy

BackgroundThe nipple-sparing mastectomy (NSM) offers a reconstruction option to patients who wish for a more subtle scar pattern and to retain their native nipple-areolar complex. Traditionally used acellular dermal matrix (ADM) has been linked to potential complications including seroma, hematoma, and infection, as well as increased operative costs. Our study examines whether using partial ADM to cover the lower pole of the breast implant during NSM prepectoral reconstruction offers comparable, or even better, rates of postoperative complications while minimizing operative costs.MethodsA retrospective chart review of patients who underwent prepectoral nipple-sparing implant-based reconstruction (IBR) using partial ADM (June 2019 - October 2020) was performed. Demographic, perioperative, and post-operative complication information was collected and described using means, standard deviations, and frequencies.ResultsNinety-eight patients (183 breasts) met inclusion criteria, with smoking history (36.73%), prior breast surgery (18.58%), and obesity (18.37%) cited as the most common comorbidities. 12.57% of patients experienced a complication following stage one of reconstruction, with infection as the most common complication (5.46%). Complication rate following stage two was 7.10%, with dehiscence cited as the most common complication (4.92%).ConclusionsThe average cost of ADM for breast reconstruction is upwards of $5,000. While our institution does not utilize full ADM coverage in NSMs, historical trends in the literature demonstrate overall complication rates of 5.9% to as high as 35%. Our study demonstrates that utilizing partial ADM coverage in the setting of NSM offers comparable, if not lower, complication rates at a fraction of the cost.Level of Evidence: Level III, risk/prognostic study.ConclusionsThe average cost of ADM for breast reconstruction is upwards of $5,000. While our institution does not utilize full ADM coverage in NSMs, historical trends in the literature demonstrate overall complication rates of 5.9% to as high as 35%. Our study demonstrates that utilizing partial ADM coverage in the setting of NSM offers comparable, if not lower, complication rates at a fraction of the cost.Level of Evidence: Level III, risk/prognostic study.