Impact and Outcome of Human Acellular Dermal Matrix Size for Immediate and Two-Stage Breast Reconstruction

Background: Following mastectomy, patients may choose to have breast reconstruction with autologous tissue or implants. Human acellular dermal matrix has been described as a tissue supplement where the implant is covered, without requiring further muscle elevation or dissection. The authors evaluated the impact of different matrix sizes. Methods: Fifty-two patients (average age, 48.5 years) and 88 operated breasts were evaluated. The cohort was divided into two, depending on matrix size. In group A, a small matrix with a surface area of 48 or 96 cm(2) was used. In group B, a larger matrix with either 128 or 160 cm(2) was used. Intraoperative fill volumes, expansion procedure, and complications were analyzed. Results: Size difference was significant (69.2 versus 135.5 cm(2)). The calculated mean initial filling volume-to-excised pathology tissue weight ratio and the initial filling-to-final implant volume ratio were significant. Average number of fills to reach final expansion volume was 62.3 percent, or 4.7 times lower in group B. Seven complications were reported without any statistical difference between groups. Conclusions: This study suggests that using a larger human acellular dermal matrix in breast reconstruction offers a potential to increase the initial expander fill volume-to-breast pathology weight ratio and initial expander fill volume-to-final implant volume ratio. Larger matrices can reduce the number of subsequent expansions and may even decrease the risk of postoperative complications. This study also revealed that using a larger matrix is a safe method that does not increase complications.