Incidence of Seromas and Infections Using Fenestrated versus Nonfenestrated Acellular Dermal Matrix in Breast Reconstructions

Abstract

Background:Acellular dermal matrices (ADMs) provide clinical benefits in breast reconstruction but have been associated with increased postoperative complications, most frequently seromas. Fenestration of the ADM before insertion into the reconstructed breast may reduce the incidence of postoperative complications. In this retrospective analysis, postoperative complications were assessed after breast reconstruction with or without fenestrated ADMs.Methods:Patients who underwent immediate 2-staged implant breast reconstructions using ADM at a single center were assessed. The number of reconstructed breasts was stratified by ADM fenestration status and ADM type. The incidence of seroma, infection, extrusion, and explantation, and cosmetic score, was compared within the 2 stratified groups. A multivariable regression was performed to identify independent risk factors associated with these complications and aesthetic outcome.Results:In total, data from 450 patients who had 603 breast reconstructions using either AlloDerm or FlexHD demonstrated a significantly higher incidence of seroma with nonfenestrated ADMs (20%) versus fenestrated ADMs (11%; P = 0.0098). Rates of infection and explantation, and cosmetic score, were not influenced by fenestration status. In the multivariable analysis, ADM fenestration remained a significant protective factor for seroma formation. FlexHD also yielded a lower incidence of extrusion (P = 0.0031) and a higher cosmetic score (P = 0.0466) compared with AlloDerm after adjusting for other risk factors.Conclusions:The results of this study support ADM fenestration for reduction of seroma incidence in breast reconstruction, without affecting cosmetic results. Additionally, the choice of ADM may reduce extrusion incidence and improve aesthetic outcomes.

Surveillance and Prevention of Surgical Site Infections in Breast Oncologic Surgery with Immediate Reconstruction

“…Risk factors identified repeatedly in multivariate analyses using institutional data or the most recent NSQIP data include obesity or increased body mass index (BMI),[38, 61–72] larger breast size,[21, 47, 66] diabetes[32, 61, 68, 69, 72, 73] or hyperglycemia,[74] smoking, [16, 42, 61, 67–69, 72, 73, 75–78] heavy alcohol use,[61, 79] older age,[16, 62, 74, 78], higher ASA score,[57, 69, 79] history of radiotherapy,[21, 42, 64, 77], duration of operation (mastectomy-only),[16, 62, 69], bilateral operation,[21, 68] and drain duration. [47, 80].…”

A review of decellurization methods caused by an urgent need for quality control of cell‐free extracellular matrix' scaffolds and their role in regenerative medicine

“…These biomaterials are characterized by sufficient biocompatibility and stability required for permanent skin substitutes. The applications of these biomaterials includes, for example, hernia reconstructive surgery, 26,27 soft tissue augmentation, breast reconstruction, 28,29 and wound healing. [30][31][32][33] The decellurization processes were subjected to a number of tissues, such as the submucosa, 34 the esophageal tissues, 35 those of the bladder, 36 the placenta, 37 the pericardium, 38 the heart valve 39,40 and the dermis.…”

Drain secretion and seroma formation after immediate breast reconstruction with a biological and a synthetic mesh, respectively: A randomized controlled study

“…In addition, if a mesh/matrix is considered a type of graft, its qualities, such as meshing and thickness, could affect surface area between the mesh/matrix and the tissue and its potential to integrate. Previously, fenestration of biological meshes has been tried as a mean to reduce the risk for complications 7,15 and it specifically seems to reduce the incidence of seromas. 7 In analogy, skin grafts are often meshed to decrease the risk of seroma formation under them.…”

“…Previously, fenestration of biological meshes has been tried as a mean to reduce the risk for complications 7,15 and it specifically seems to reduce the incidence of seromas. 7 In analogy, skin grafts are often meshed to decrease the risk of seroma formation under them. In the present study, a nonfenestrated biological mesh was compared with a loosely knitted synthetic mesh.…”

“…Studies have indicated that the seroma formation varies with different types of matrices. 6,7 Nonetheless, most of the reports on seroma formation concern biological matrices 1 and there are no studies comparing seroma formation in biological and synthetic meshes. The aim of this study was to compare seroma production in implant-based immediate breast reconstruction with a biological mesh with that of a synthetic mesh, in the same patient.…”