Background:Human acellular dermal matrix (HADM) is commonly used to provide coverage and support for breast reconstruction. The primary purpose of this study was to evaluate the complication rates associated with breast reconstruction procedures when performed in conjunction with multiple types of HADM in a consecutive series.Methods:After receiving institutional review board approval, medical records from a single surgeon were retrospectively reviewed for 126 consecutive patients (170 breasts and 211 procedures) who received a breast reconstruction or revision with implantation of HADM between 2012 and 2014. Patient demographics, surgical technique, and the complication profile of 4 major types of HADM were evaluated by procedure. Complication data were primarily evaluated for infection, seroma formation, necrosis, and other complications requiring additional surgery.Results:The total complication rate was 19.4%. The complication rates were not statistically different between all 4 types of HADM: Alloderm (n = 143); Alloderm RTU (n = 19); FlexHD (n = 18); hMatrix (n = 32) (P > 0.05). Smokers and large-breasted women (≥500 g) had a significantly higher complication rate than the rest of the population (P < 0.01 and P < 0.03, respectively). The complication rates associated with all other patient cohorts analyzed (age, body mass index, comorbid conditions, cancer diagnosis, prepectoral technique) showed no influence on complication rates (P > 0.05).Conclusions:In characteristically similar cohorts, there was no statistically significant difference in complication rates based on type of HADM; however, certain risk factors and anatomy should be considered before HADM-assisted breast reconstruction.

The commonly used methods to quantify axon numbers and mean area include manual and semiautomated procedures. The authors introduce a new fully automated method of morphometric analysis using ImageJ and Paint.net software to improve efficiency and accuracy. A total of six rat sciatic nerves were examined for their axon numbers and mean axon area by comparing the manual method or semiautomated MetaVue method with the new ImageJ method. It was observed that the number of axons for manual counting and ImageJ were 4,630 ± 403 and 4,779 ± 352, respectively, and the difference was not statistically significant (p > 0.5, t-test). The mean axon area measured was 13.44 ± 2.62 µm2 for MetaVue and 8.87 ± 0.78 µm2 for ImageJ, respectively, and the difference was statistically significant (p < 0.01, t-test). The standard error and coefficient of variation of MetaVue were 1.07 and 0.195; and for ImageJ were 0.32 and 0.087. The authors conclude that their new approach demonstrates improved convenience, time efficiency, accuracy, and less operator error or bias.

Introduction: Class 3 (severe) obesity is defined as a body mass index (BMI) greater than 40 kg/m 2 . Obesity is common and an independent risk factor for breast cancer.The plastic surgeon will be tasked with providing reconstruction for obese patients after mastectomy. This presents a surgical dilemma because patients with elevated BMI are known to have greater rates of morbidity when undergoing free flap reconstruction, however free flap reconstruction is associated with greater functional and aesthetic outcomes. This study quantifies complication rates in a cohort of patients with class 3 obesity that underwent abdominally based free flap breast reconstruction. This study may be able answer whether this surgery is feasible or safe.Methods: Patients with a class 3 obesity who underwent abdominally-based free flap breast reconstruction between January 1, 2011 and February 28, 2020 at the authors' institution were identified. A retrospective chart review was performed to record patient demographics and peri-operative data.Results: Twenty-six patients met inclusion criteria. Eighty percent of patients had at least one minor complication including infection (42%), fat necrosis (31%), seroma (15%), abdominal bulge (8%), and hernia (8%). Thirty-eight percent of patients had at least one major complication (requiring readmission (23%) and/or a return to the operating room (38%)). No flaps failed. Conclusion:Abdominally based free flap breast reconstruction in patients with class 3 obesity is associated with great morbidity, however, no patients experienced flap loss or failure which may imply that this population can safely undergo surgery so long as the surgeon is prepared for complications and takes steps to mitigate risk.

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