Early complications in cases series in implant-based immediate breast reconstruction with a biological acellular matrix during the learning curve of this technique and using 3 different matrices: a case series of 84 breasts

Introduction: We present our experience in implant-based immediate breast reconstruction (IBIBR) with biological acellular matrix during our learning curve and compare the complications with the use of three different matrices. Materials and methods: We did a retrospective study on patients who underwent an IBIBR with acellular matrix after skin sparing mastectomy with or without nipple-areolar complex preservation at the Breast Pathology Unit at University Hospital Vall d’Hebron, Barcelona (Spain) between July 2011 and December 2014. Results: A total of 84 breasts were reconstructed in 71 women. A therapeutic mastectomy was performed in 55 of them (65.5%) and a prophylactic mastectomy in 29 (34.5%). The total rate of complications was 41.67% (35 patients): we found 11 cases of erythema (13.1%), 19 cases of seroma (22.62%), 9 cases of hematoma (10.71%), 17 cases of wound dehiscence (20.24%), 11 cases of skin flap necrosis (13.1%), and 10 cases of reconstruction failure (11.9%). The probability of reconstruction failure was higher in smokers and former smokers (P=0.0011%). There were more complications with the Protexa matrix than with the other 2, Strattice and Tutomesh (P<0.001) and a higher risk of reconstruction failure as well (P=0.03). Conclusions: In our experience the use of acellular matrix in IBIBR can have a high rate of complications, especially during the learning curve. Therefore, the selection of suitable patients and the better matrix is an issue of great importance to achieve favorable results.