Predictors of complications after direct-to-implant breast reconstruction with an acellular dermal matrix from a multicentre randomized clinical trial

BackgroundIn the multicentre randomized trial BRIOS (Breast Reconstruction In One Stage), direct-to-implant (DTI) breast reconstruction with an acellular dermal matrix (ADM) was associated with a markedly higher postoperative complication rate compared with two-stage tissue expander/implant breast reconstruction. This study aimed to identify factors that contribute to the occurrence of complications after DTI ADM-assisted breast reconstruction. MethodsData were obtained from the BRIOS study, including all patients treated with DTI ADM-assisted breast reconstruction. Logistic regression analyses were performed to identify factors predictive of postoperative complications. ResultsFifty-nine patients (91 breasts) were included, of whom 27 (35 breasts) developed a surgical complication. Reoperations were performed in 29 breasts (32 per cent), with prosthesis removal in 22 (24 per cent). In multivariable analyses, mastectomy weight was associated with complications (odds ratio (OR) 194, 95 per cent c.i. 133 to 283), reoperations (OR 170, 112 to 259) and removal of the implant (OR 155, 111 to 217). Younger patients (OR 107, 101 to 113) and those who received adjuvant chemotherapy (OR 483, 115 to 2024) more frequently required reoperation. In univariable analyses, adjuvant radiotherapy showed a trend towards more complications (OR 723, 075 to 6995) and removal of the implant (OR 512, 076 to 3444), without reaching statistical significance. ConclusionBreast size appeared to be the most significant predictor of complications in DTI ADM-assisted breast reconstruction. The technique should preferably be performed in patients with small to moderate sized breasts. Registration number: NTR5446 (http://www.trialregister.nl). Not good for the large breast