Immediate Implant-Based Breast Reconstruction with Acellular Dermal Matrix: A Comparison of Sterile and Aseptic AlloDerm in 2039 Consecutive Cases

Background: Sterile, ready-to-use acellular dermal matrix (RTU ADM), introduced as an alternative to aseptic, freeze-dried acellular dermal matrix (FD ADM) for implant-based breast reconstruction (IBR), has been investigated in a limited number of studies. The purpose of this study was to compare outcomes in IBR with RTU ADM and FD ADM. Methods: We analyzed patients undergoing IBR with either FD ADM or RTU ADM, including demographics, clinical variables, and outcomes. An a priori power analysis was performed and logistic regression modeling was used to quantify the effect of ADM on outcomes while controlling for potential confounders. Results: 1285 consecutive patients undergoing 2039 immediate prosthetic breast reconstructions comprised the population: 612 (n=910 breasts) with FD ADM and 673 (n=1129 breasts) with RTU ADM. The FD ADM cohort had a significantly higher rate of explantation compared to RTU ADM cohort (18.0% versus 12.0%, p = 0.0036), but surgical site infection, wound dehiscence, mastectomy flap necrosis, seroma, and hematoma did not differ significantly between groups. On multivariate regression, patients having reconstruction with FD ADM, compared to RTU ADM, did not have higher odds of experiencing surgical site infections (OR 1.064, p = 0.7455), but did have higher odds of explantation (OR 1.570, p = 0.0161). Tobacco use (OR 2.809, p = 0.0002) and BMI (OR 1.054, p