A Comparison of Dermal Autograft and Acellular Dermal Matrix in Tissue Expander Breast Reconstruction: Long-term Aesthetic Outcomes and Capsular Contracture

Abstract

Background: The use of acellular dermal matrix (ADM) in tissue expander breast reconstruction has been touted to reduce capsular contracture rates and improve aesthetic outcomes. Autogenous dermal grafts have shown to be a safer and more cost-effective alternative to ADM. The purpose of this study was to compare the capsular contracture rates and long-term aesthetic outcomes of tissue expander breast reconstruction using dermal autografts with ADM-assisted reconstruction.

Methods: Patients undergoing tissue expander breast reconstruction with either ADM or dermal autografts were enrolled. Autografts were harvested from the lower abdomen. The capsular contracture rate was assessed via physical examination using the Baker scale. Standardized patient photographs were scored for aesthetic appearance on a 7-point Likert scale by blinded female observers. The ADM and autograft groups were compared using Student t test. Significance was defined as P < 0.05.

Results: Forty-eight patients were enrolled (76 breasts). The average follow-up time for the ADM group was 9.6 months and 9.9 months for the dermal autograft group. Twenty-seven patients received ADM, and 21 patients received dermal autograft. Capsular contracture scores were identical between the 2 groups (mean Baker grade = 1.15, P = 0.55). The average long-term aesthetic outcome score for dermal autograft-assisted breast reconstruction was 3.85, compared to 3.79 for ADM-assisted reconstruction. This difference was not statistically significant (P = 0.87).

Conclusions: In addition to an improved safety profile and lower cost, dermal autograft-assisted tissue expander breast reconstruction affords equivalent aesthetic results and capsular contracture rates, when compared to ADM.