Infectious Complications Leading to Explantation in Implant-Based Breast Reconstruction With AlloDerm

Objective: The role for acellular dermal matrix in implant-based breast reconstruction—providing coverage of the inferolateral border of the underlying prosthesis and allowing control over the inframammary fold—has become increasingly popular. Although AlloDerm (LifeCell, Branchburg, NJ) is free of cellular components responsible for the antigenic response, its processing does not guarantee sterility. In this study, we examine the infectious complications in tissue expander/implant-based reconstruction with AlloDerm. Methods: A retrospective cohort analysis was completed on 321 implant-based breast reconstructions over a 10-year period (1998–2008) at an academic institution. Of these cases, 75 reconstructions used AlloDerm and 246 reconstructions did not. The incidence of infections that required readmission for intravenous (IV) antibiotics and explantation was determined. Prosthetic explants due to hematoma or patient dissatisfaction were excluded from analysis. Results: There were no differences in rates of readmission for IV antibiotics (2.8% vs 5.3%; P = .291). The rate of explantation due to infected fluid collections and extrusion was higher in the AlloDerm group (8.0%, n = 6) than that in the control group (1.6%, n = 4). This result was statistically significant (P = .013). Conclusion: In this study, the rates of IV antibiotic administration for the treatment of cellulitis in implant-based breast reconstructions did not differ because of the presence of AlloDerm; however, the rate of explantation was statistically higher in reconstructions using AlloDerm. This technique has great potential in breast reconstruction, especially for single-staged implant-based reconstruction, but careful counseling of patients with regard to the higher risk of explantation is necessary.