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Arch Plast Surg > Volume 46(3); 2019 > Article
Archives of Plastic Surgery 2019;46(3):204-213.
DOI:    Published online May 15, 2019.
A comparative study between sterile freeze-dried and sterile pre-hydrated acellular dermal matrix in tissue expander/implant breast reconstruction
Jeong Hyun Cheon  , Eul Sik Yoon  , Jin Woo Kim  , Seung Ha Park  , Byung Il Lee 
Department of Plastic and Reconstructive Surgery, Korea University College Medicine, Seoul, Korea
Correspondence:  Eul Sik Yoon, Tel: +82-2-920-5368, Fax: +82-2-922-7437, 
Received: 17 September 2018   • Revised: 17 February 2019   • Accepted: 6 March 2019
In implant-based breast reconstruction, acellular dermal matrix (ADM) is essential for supporting the inferolateral pole. Recent studies have compared non-sterilized freeze-dried ADM and sterilized pre-hydrated ADM, but have not assessed whether differences were attributable to factors related to sterile processing or packaging. This study was conducted to compare the clinical outcomes of breast reconstruction using two types of sterile-processed ADMs.


Through a retrospective chart review, we analyzed 77 consecutive patients (85 breasts) who underwent tissue expander/implant breast reconstruction with either freezedried ADM (35 breasts) or pre-hydrated ADM (50 breasts) from March 2016 to February 2018. Demographic variables, postoperative outcomes, and operative parameters were compared between freeze-dried and pre-hydrated ADM. Biopsy specimens were obtained for histologic analysis.


We obtained results after adjusting for variables found to be significant in univariate analyses. The total complication rate for freeze-dried and pre-hydrated ADMs was 25.7% and 22.0%, respectively. Skin necrosis was significantly more frequent in the freeze-dried group than in the pre-hydrated group (8.6% vs. 4.0%, P=0.038). All other complications and operative parameters showed no significant differences. In the histologic analysis, collagen density, inflammation, and vascularity were higher in the pre-hydrated ADM group (P=0.042, P=0.006, P=0.005, respectively).


There are limited data comparing the outcomes of tissue expander/implant breast reconstruction using two types of sterile-processed ADMs. In this study, we found that using pre-hydrated ADM resulted in less skin necrosis and better integration into host tissue. Pre-hydrated ADM may therefore be preferable to freeze-dried ADM in terms of convenience and safety.
Keywords: Breast implants / Acellular dermis / Mammaplasty / Sterilization
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