The partial AlloDerm™ sling: Reducing allograft costs associated with breast reconstruction

https://doi.org/10.1016/j.bjps.2012.02.016Get rights and content

Summary

Background

Many surgeons now incorporate Acellular Dermal Matrix (ADM) into expander-based breast reconstruction. ADM is safe, provides full expander coverage, eliminates the need for additional muscular dissection and has improved aesthetic outcomes. However, its use increases surgical costs. Whether this cost is offset by decreased operative times or a reduced number of revision procedures is unknown.

Methods

We have developed a new technique that minimises the amount of ADM required in many patients. The ‘partial sling’ approach has been used for 145 consecutive patients (197 breasts) by a single surgeon from 2007 to 2010. After mastectomy, any portion of the pectoralis major insertion at, or <1 cm from, the planned inframmary fold is left intact and becomes the inferior margin of the expander pocket. The minimal size of ADM required is then determined by measuring from the pectoralis to the lateral breast margin. In this study, we exclusively used AlloDerm™. Preoperative breast measurements, intra-operative fill volume, time to exchange procedure, number of expansion procedures and complications were recorded for all patients.

Results

Patients were grouped according to the surface area (cm2) of ADM required. Good aesthetic outcomes were obtained in all groups. Two groups had a significant difference in intra-operative fill volumes but this did not correlate to an increase in the number of expansion procedures required. Of 197 reconstructed breasts less than 64 cm2 of ADM was used for 40 breasts (20%).

Conclusions

The partial AlloDerm™ sling can minimise the costs associated with ADM use in breast reconstruction for many patients without increasing complications or altering aesthetic outcomes.

Section snippets

Study design

We retrospectively studied outcomes of 145 consecutive patients who underwent delayed or immediate breast reconstruction with tissue expanders (CPT 19357) and ADM by a single surgeon from 2007 to 2010. The chart review was approved by our institutional review board. Preoperative data recorded included age, body mass index, medical history, prior breast surgery and breast measurements. Breast measurements included sternal notch to nipple, nipple to IMF and base width. Intra-operative

Results

From 2007 to 2010, 145 women (197 breasts) aged 21–78 years (mean 50.4 years) underwent immediate or delayed breast reconstruction using tissue expanders by a single surgeon. Of the 197 mastectomies performed, 93 were unilateral and 52 were bilateral (Table 1). Mastectomy techniques used were skin-sparing (124 patients), nipple-sparing (37 patients), complete mastectomy or modified radial mastectomy (34 patients). Two patients had previously undergone mastectomy and underwent delayed

Discussion

Immediate or delayed expander-based breast reconstruction remains the most commonly performed technique.2 The use of ADM to create an expander or implant pocket decreases operative time, patient morbidity and improves aesthetic outcomes when compared to full muscular coverage.3, 8 One of the drawbacks to its use is the associated cost ($30/cm2).12

The amount of ADM used varies by surgeon and the type of reconstruction. Spear et al. preoperatively measure the arc length of the IMF and use either

Conflict of interest

No authors have any financial conflict of interest to report.

Financial disclosure

No funding was received for this work.

Ethical standards

The presented work has been approved by the University Hospitals – Case Medical Center Institutional Review Board (#05-10-24).

References (14)

  • V. Bindingnavele et al.

    Use of acellular cadaveric dermis and tissue expansion in postmastectomy breast reconstruction

    J Plast Reconstr Aesthet Surg

    (2007)
  • C. Radovan

    Breast reconstruction after mastectomy using the temporary expander

    Plast Reconstr Surg

    (1982)
  • American Society of Plastic Surgeons

    Breast reconstruction statistics

    (2010)
  • K.H. Breuing et al.

    Immediate bilateral breast reconstruction with implants and inferolateral AlloDerm slings

    Ann Plast Surg

    (2005)
  • R.J. Zienowicz et al.

    Implant-based breast reconstruction with allograft

    Plast Reconstr Surg

    (2007)
  • R.W. Bernard et al.

    Subincisional muscular coverage of expander implants in immediate breast reconstruction with pectoralis flaps

    Ann Plast Surg

    (2005)
  • S.L. Spear et al.

    Immediate breast reconstruction in two stages using textured, integrated-valve tissue expanders and breast implants

    Plast Reconstr Surg

    (2004)
There are more references available in the full text version of this article.

Cited by (0)

View full text