{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:46:32Z","timestamp":1787237192509,"version":"build-2736575974"},"reference-count":14,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>In the United States, approximately 57,000 tissue expander\/implant-based breast reconstructions are performed each year. Complete submuscular tissue expander coverage affords the best protection against implant exposure but can restrict lower pole expansion. The benefits of using acellular dermal matrix are enticing, but questions remain as to whether or not its presence increases reconstructive failures. The purpose of this study was to investigate predictors of explantation in those patients with acellular dermal matrix reconstructions and to discuss salvage techniques.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>An approved retrospective review was conducted of 137 patients undergoing 234 individual breast reconstructions over 4 years performed by a single plastic surgeon (J.D.) at a single institution. Patients who underwent implant-based reconstruction with either immediate placement of a tissue expander that was subsequently exchanged for a permanent implant at a second operation or immediate placement of a permanent implant when indicated were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      One hundred thirty-seven patients who underwent 234 implant-based breast reconstructions using acellular dermal matrix met criteria. There was an overall 23 percent complication rate, including any cellulitis, seroma, skin necrosis, and hematoma formation. Significant preoperative risk factors for any postoperative complication included body mass index greater than 25 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      and a history of radiation therapy before acellular dermal matrix placement. Radiation therapy was found to be a significant risk factor for postoperative skin necrosis. Of explantations, many fluid cultures grew Gram-negative bacteria.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Skin necrosis is a serious risk factor for explantation in implant-based reconstruction with acellular dermal matrix. The reconstructive surgeon should consider early excision of any skin necrosis as soon as it is identified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CLINICAL QUESTION\/LEVEL OF EVIDENCE:<\/jats:title>\n                    <jats:p>Risk, III.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/prs.0000000000007702","type":"journal-article","created":{"date-parts":[[2021,3,12]],"date-time":"2021-03-12T11:00:43Z","timestamp":1615546843000},"page":"579e-586e","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":13,"title":["Explantation in Tissue Expander and Direct-to-Implant Reconstruction with Acellular Dermal Matrix: How to Avoid Early Reconstructive Failures"],"prefix":"10.1097","volume":"147","author":[{"given":"Leslie E.","family":"Cohen","sequence":"first","affiliation":[{"name":"From the Department of Plastic Surgery, Memorial Sloan Kettering Cancer Center."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jarrod T.","family":"Bogue","sequence":"additional","affiliation":[{"name":"From the Department of Plastic Surgery, Memorial Sloan Kettering Cancer Center."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Jin","sequence":"additional","affiliation":[{"name":"From the Department of Plastic Surgery, Memorial Sloan Kettering Cancer Center."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph J.","family":"Disa","sequence":"additional","affiliation":[{"name":"From the Department of Plastic Surgery, Memorial Sloan Kettering Cancer Center."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,3,12]]},"reference":[{"key":"R2-20250501","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.1097\/PRS.0b013e3181bf803d","article-title":"Acellular dermis-assisted prosthetic breast reconstruction versus complete submuscular coverage: A head-to-head comparison of outcomes.","volume":"124","author":"Sbitany","year":"2009","journal-title":"Plast Reconstr Surg"},{"key":"R3-20250501","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1097\/SAP.0b013e3181f3ed0a","article-title":"Tissue expander breast reconstruction using prehydrated human acellular dermis.","volume":"66","author":"Rawlani","year":"2011","journal-title":"Ann Plast Surg"},{"key":"R4-20250501","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1177\/1090820X10366547","article-title":"Acellular dermis-assisted breast reconstruction with the use of crescentric tissue expansion: A functional cosmetic analysis of 40 consecutive patients.","volume":"30","author":"Buck","year":"2010","journal-title":"Aesthet Surg J"},{"key":"R5-20250501","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/01.sap.0000214873.13102.9f","article-title":"Nonexpansive immediate breast reconstruction using human acellular tissue matrix 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Surg"},{"key":"R13-20250501","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1097\/PRS.0b013e31829fe35b","article-title":"Sterile \u201cready-to-use\u201d AlloDerm decreases postoperative infectious complications in patients undergoing immediate implant-based breast reconstruction with acellular dermal matrix.","volume":"132","author":"Weichman","year":"2013","journal-title":"Plast Reconstr Surg"},{"key":"R14-20250501","doi-asserted-by":"crossref","first-page":"194","DOI":"10.5999\/aps.2015.42.2.194","article-title":"Early surgical-site infection following tissue expander breast reconstruction with or without acellular dermal matrix: National benchmarking using National Surgical Quality Improvement Program.","volume":"42","author":"Winocour","year":"2015","journal-title":"Arch Plast Surg"},{"key":"R15-20250501","doi-asserted-by":"crossref","first-page":"1606","DOI":"10.1097\/PRS.0b013e3181d4fb2a","article-title":"Acellular human dermis implantation in 153 immediate two-stage 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