Postoperative complications of ADM use in previously irradiated patients during stage I of implant-based breast reconstruction: A national database propensity score-matched analysis

Introduction: Acellular dermal matrix (ADM) is widely used in implant-based reconstruction to prevent capsular contracture, but its safety in irradiated patients is underexplored. We aimed to evaluate postoperative complications associated with ADM use in stage I of implant-based breast reconstruction in patients with premastectomy radiation. Methods: Using the Merative MarketScan Research Databases, 2012-2020, previously irradiated patients undergoing outpatient stage I implant breast reconstruction (prepectoral and submuscular) were stratified by ADM use and propensity score-matched. Postoperative complications and additional surgical interventions within 90 days were analyzed using multivariate logistic regression. Results: Among 1234 matched patients (617 ADM and 617 non-ADM), ADM use was first recorded in 2012, and its frequency showed a positive correlation over the study (r = 0.214, p <.001). Patients with ADM experienced higher rates of wound (8.5% vs. 7.8%) and tissue necrosis (5.5% vs. 4.0%) than non-ADM patients, but these differences were not statistically significant. Additionally, no significant differences were observed between ADM and non-ADM groups in the rates of seroma formation, hematoma, fat necrosis, or postoperative infections. ADM use was associated with significantly lower odds of requiring image-guided fluid drainage for hematomas or seromas (OR 0.11, 95% CI 0.01-0.89, p =.039). Conclusion: No significant difference in complication rates was found between previously irradiated breast cancer patients with and without ADM on a large scale, even with ADM usage increasing over time. Its adoption should balance cost, surgeon preferences, and esthetic outcomes, with further research needed on its role in various reconstruction planes and cost impacts. (c) 2025 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.