J Plast Surg Hand Surg, 2013; 47: 308–312 © 2013 Informa Healthcare ISSN: 2000-656X print / 2000-6764 online DOI: 10.3109/2000656X.2013.766202 ORIGINAL ARTICLE The effect of acellular dermal matrix on drain secretions after immediate prosthetic breast reconstruction Hadar Israeli Ben-noon 1 , Nimrod Farber 1 , Oren Weissman 1 , Ariel Tessone 1,2 , Demetris Stavrou 1 , Moshe Shabtai 3 , Yasmin Maor 4 , Joseph Haik 1,2 & Eyal Winkler 1 1 Department of Plastic and Reconstructive Surgery, 2 The Talpiot Medical Leadership Program, 3 Department of General Surgery B and 4 The Infectious Disease Unit, Sheba Medical Center, Tel-Hashomer, Israel Abstract In recent years the acellular dermal matrix (ADM) has gained popularity in prosthetic breast reconstruction. These procedures involve placement of a closed suction drain in the reconstructed breast. Although it is now widely accepted that ADM has an overall positive effect on the outcome of breast reconstruction, data regarding its effect on postoperative drain secretions is lacking. This study was designed to quantitatively evaluate the influence of ADM on postoperative drain secretions in the setting of immediate prosthetic breast reconstruction (IPBR). This is a prospective, comparative controlled study. Two groups of 16 patients each underwent skin sparing mastectomies (SSM) and IPBR with or without ADM. Closed suction drains were left in all the reconstructed breasts and daily secretion volumes were recorded and compared. Postoperative complications were also noted. Patients in the ADM group showed higher daily and overall secretion volumes compared with patients in the control group (p = 0.014) and the time for removal of the drains was higher by an average of 5 days (13 compared with 8 days, respectively; p = 0.004). There was no correlation between ADM and infection. This study provides the first objective evidence that ADM contributes to elevated and prolonged drain secretions when used for IPBR. This might affect possible prosthesis-related complications (e.g., rotation and malposition, capsular contraction, seroma formation, and infection). This study also noted erythema of the post-mastectomy skin flaps in selected patients, which may be attributable to a local inflammatory reaction to the ADM rather than infection. Key Words: Breast reconstruction, breast implants, breast, ADM (acellular dermal matrix), Alloderm, drain’s secretions, breast drain Introduction Prosthetic breast reconstruction with tissue expanders or perma- nent implants is the most common method for immediate recon- struction after mastectomy [1]. Since its introduction by Breuing and Warren [2] in 2005, the acellular dermal matrix (ADM) has become an important adjunct to immediate prosthetic breast reconstruction (IPBR). ADM is a human cadaver-derived acellular dermal matrix that has been depleted of all cellular and antigenic components. The remaining matrix includes collagen, fibronectin, elastin, hyaluronan, and proteoglycans. Since ADM is non- antigenic and biocompatible it becomes incorporated into the surrounding soft tissue [3]. ADM reduces the tension over thin post-mastectomy skin flaps; it provides coverage of the prosthetic device in conjunction with the pectoralis major muscle alone while sparing adjacent muscles, thus lowering the risk for donor site morbidity and decreasing operating time; finally, ADM enhances the definition of the inframammary fold and leads to an overall superior cosmetic result [4,5]. Furthermore, animal and human studies suggest that ADM may prevent capsular contracture [6,7]. Recently, several publications raised the question of whether ADM is linked to higher rates of postoperative seroma and infection [8–10], however there is no published data regarding the effect of ADM on drain secretions after IPBR. We present the first study that prospectively measured secretion volumes and associated infections among patients undergoing IPBR with or without ADM. Patients and methods This prospective, comparative controlled study was approved by the Institutional Review Board of the Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel. We collected data from 16 con- secutive patients who underwent 24 SSM and IPBR with ADM and from 16 consecutive patients who underwent 23 SSM and IPBR without ADM (control group). Patients were assigned to the study group if they bought the ADM, otherwise they were assigned to the control group. Data included demographic and anthropo- metric parameters, past medical history and risk factors, data from both surgical phases (mastectomy and reconstruction), and post- operative evaluation. Patient characteristics are listed in Table I. Antimicrobial prophylaxis A prophylactic regimen was determined in conjunction with the infectious disease consultants at our institution and consisted of a first-generation cephalosporin (Cefazolin) administered intra- venously 30 minutes before the operation and continued thrice daily for 48 hours postoperatively, followed by an oral agent (Cefalexin) for an additional 48 hours (patients with known or suspected hypersensitivity to penicillin or cephalosporin were given Clindamycin). Surgical technique All SSM were performed by a team of general surgeons. Reconstructions were performed by a plastic surgery team Correspondence: Hadar Israeli Ben-noon, MD, Department of Plastic and Reconstructive Surgery and Burn Unit, The Chaim Sheba Medical Center, Tel-Hashomer, IL-52621 Ramat Gan, Israel. Tel: +972-3-5302416. Fax: +972-3-5302248. E-mail: israelihmd@gmail.com (Accepted 17 September 2012)