Battle of the Brands: A Multicenter Comparative Analysis of Outcomes in Immediate Implant-based Breast Reconstruction With Acellular Dermal Matrices
Christian X. Lava, Karen R. Li, Nicole C. Episalla, Lauren E. Berger, Rachel N. Rohrich, Claire L. Holmvik, Nichole G. Andrade, Jie Jung Shih, Kana Behari, Laura K. Tom, Rajiv P. Parikh, Samer F. Jabbour, Kenneth L. FanBackground:
We conducted a head-to-head study comparing outcomes among commonly used implant brands, Allergan, Mentor, and Sientra, used in breast reconstruction.
Methods:
A multicenter retrospective review of patients undergoing acellular dermal matrix–assisted implant-based breast reconstruction (IBR) with Allergan, Mentor, or Sientra implants between January 2014 and July 2022 was conducted. Primary outcomes included rates of return to the operating room for implant removal. Secondary outcomes included complications occurring within 30 days, between 31 and 60 days, and after 60 days.
Results:
A total of 631 patients (1155 breasts) underwent IBR: Allergan (n = 280 breasts, 24.2%), Mentor (n = 714, 61.7%), Sientra (n = 161, 13.9%). Mean age was 49.2 ± 11.4 years. Mean body mass index was 25.6 ± 5.4 kg/m 2 . One hundred ninety-nine (17.2%) breasts underwent adjuvant radiation and 168 (14.5%) underwent neoadjuvant chemotherapy. Implants were most often inserted in the prepectoral plane (n = 584, 50.6%). After 60 days, there were no significant differences in overall complication rates between brands. One hundred sixty-one (13.9%) breasts underwent eventual reoperation, including unplanned explantation (n = 95, 8.2%), elective revision (n = 94, 8.1%), oncological indications (n = 20, 1.7%), and infection (n = 15, 1.3%). Indications for unplanned explantation included infection (n = 26, 2.3%), capsular contracture (n = 15, 1.3%), and nonhealing wounds (n = 14, 1.2%). There were no differences in other complications or reoperations between cohorts. Body mass index, diabetes mellitus, smoking history, chemotherapy, radiation, skin-sparing mastectomy, type of incision, and tissue expander use were independent predictors of postoperative complications.
Conclusions:
Low rates of complications among Allergan, Mentor, and Sientra implants in IBR support their continued use. No single brand was superior to others regarding complication profile in our study. Patient characteristics and operative approach seem more predictive of postoperative outcomes than the implant brand alone.