Porcine Acellular Dermis–Assisted Breast Reconstruction: Influence of Adjuvant Radiotherapy on Complications and Outcomes

BACKGROUND: Implant-based reconstruction is the most frequently performed breast reconstruction procedure. A persistent issue with this approach is optimizing outcomes in the setting of radiotherapy. Experimental evidence suggests that acellular dermal matrix use may provide a protective benefit, but clinical evidence is lacking. The purpose of this study was to assess postoperative complications and the effect of radiotherapy on complications and outcomes in women who underwent immediate, porcine acellular dermal matrix (PADM, Strattice)-assisted, implant-based breast reconstruction postmastectomy. METHODS: Patients with at least 1 year of follow-up were included in this retrospective study. Patient charts were reviewed for demographic data, adjunctive therapy use, duration of follow-up, and type and incidence of complications during follow-up. RESULTS: A total of 158 reconstructions were performed in 103 patients. Adjuvant therapy included chemotherapy in 51% of patients and radiotherapy in 25% of breasts. Mean follow-up was 36.2 months. Complications occurred in 17 breasts (10.8%): implant/expander loss (8.2%); infection (5.7%); dehiscence (3.8%); eschar (1.9%); and ischemia, hematoma, and seroma (0.6% each). Nine breasts with complications had been irradiated; all were irradiated prereconstruction. Rate of total complications, implant/expander loss, and dehiscence was significantly higher in irradiated breasts. Breasts irradiated postreconstruction had no complications. CONCLUSIONS: Addition of PADM to implant-based reconstruction is associated with acceptable complication rates comparable to those observed with standard submuscular reconstructions. Complications are increased in the setting of radiotherapy; but PADM use may protect against the adverse effects of postreconstruction radiotherapy.