The Rate of Return to the Operating Room for Acellular Dermal Matrix (ADM) Versus Non-ADM Direct to Implant Breast Reconstruction: An Economic Analysis for an Integrated Healthcare System

Acellular dermal matrix (ADM) is commonly used for breast reconstruction with the proposed benefit of stabilizing the implant pocket and enhancing breast shape. However, some reports highlight safety concerns regarding ADM use. This study evaluates short and long-term unplanned return to the operating room (OR) for immediate implant-based reconstruction with or without ADM. Females who underwent primary mastectomy with direct to implant reconstruction for breast cancer or risk reduction (2010–2020) were identified using an integrated healthcare system’s EHR. Multivariable Poisson regression was conducted to evaluate return to OR outcomes at early (<1 year), intermediate (1–2 years), and long term (≥2 years) periods for ADM versus without. The cohort included 2886 patients, 69.8% with ADM. Overall, no differences were observed for OR returns for ADM compared to none. For unilateral procedures, a lower rate of return to OR was observed at 0–1 year (IRR = 0.74, 95% CI = 0.58–0.95) and >2 years (IRR = 0.52, 95% CI = 0.29–0.94). The lack of overall difference suggests ADM usage did not impact risk of complications nor improve surgical outcomes. For unilateral cases, ADM is associated with lower rates of return to OR at a higher cost to the healthcare system. Surgeons may use their discretion whether ADM is appropriate for breast reconstruction.