Background:Breast reconstruction following mastectomy has become an essential procedure in breast cancer treatment due to its positive impact on patients’ quality of life. Among the various reconstruction techniques, the use of expanders followed by implants has gained popularity. In this context, acellular dermal matrices (ADM) have been introduced as an adjunct to improve implant coverage, lower pole support, and aesthetic outcomes. However, their use has also been associated with higher costs and a potential increase in postoperative complications, which remains a matter of debate. We aimed to determine the relationship between acellular dermal matrix and postoperative outcomes and complications. Methods: An observational retrospective study was conducted with patients who underwent immediately breast mastectomy followed by tissue expander reconstruction from January 2022 to June 2024. Patients were divided into two groups depending on reconstructive plane.Results: The final cohort contained 87 patients. Smoking, radiotherapy and dermal matrix were associated with a higher complication rates. After risk-adjustment, dermal matrix use led to a higher rates of surgical site infection (OR 7.62,p= 0.029) in the prepectoral plane, and higher rates of overall complications (OR 3.34,p= 0.05) and surgical wound dehiscence (OR 6.04,p= 0.048) in the retropectoral plane.Conclusions: These findings highlight the importance of individualized surgical planning, particularly concerning the use of acellular dermal matrix, which were associated with increased risks of surgical site infection, dehiscence, and global complications. Further research is required to establish standardized guidelines for the optimal selection surgical technique.
背景：乳房切除术后乳房重建因其对患者生活质量的积极影响，已成为乳腺癌治疗中的重要环节。在各种重建技术中，扩张器联合假体植入术的应用日益广泛。在此背景下，脱细胞真皮基质（ADM）作为辅助材料被引入，旨在改善假体覆盖、加强下极支撑并提升美学效果。然而，其使用也伴随着较高的费用及术后并发症风险的潜在增加，这一问题仍存在争议。本研究旨在明确脱细胞真皮基质与术后效果及并发症之间的关系。 方法：本研究对2022年1月至2024年6月期间接受即刻乳房切除并随后进行组织扩张器重建的患者开展了一项观察性回顾性研究。根据重建平面将患者分为两组。 结果：最终队列共纳入87例患者。吸烟、放疗及使用真皮基质与较高的并发症发生率相关。经风险调整后，在胸肌前平面，真皮基质的使用导致手术部位感染率更高（OR 7.62，p=0.029）；在胸肌后平面，则与总体并发症发生率（OR 3.34，p=0.05）及手术伤口裂开率（OR 6.04，p=0.048）的升高相关。 结论：这些发现强调了制定个体化手术方案的重要性，尤其是在使用脱细胞真皮基质方面，因其与手术部位感染、伤口裂开及总体并发症的风险增加相关。未来需要进一步研究以建立标准化指南，优化手术技术的选择。
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