A Propensity Score-Matched Analysis of Breast Reconstruction Outcomes Stratified by Type of Acellular Dermal Matrix

INTRODUCTION: Acellular dermal matrix (ADM) is commonly incorporated in breast reconstruction to enhance soft tissue support. However, literature comparing ADM types remains limited. Differences in processing, sterility, and biologic integration may contribute to outcomes. This multi-institutional study evaluates complications associated with major ADM types in prosthetic breast reconstruction. METHODS: The TriNetX US Collaborative Network, a database including over 114 million patients from 67 healthcare organizations between 2007 and November 2025, was queried to identify patients undergoing mastectomy with direct-to-implant or tissue expander placement. Same-day ADM use and specific ADM types were identified using Q-codes. Table 1 lists the five ADM products included, along with descriptors of their processing characteristics. Patients were stratified by ADM use and type. Propensity-score matching balanced baseline characteristics. Postoperative outcomes within 90 days, including implant/TE removal, surgical site infection (SSI), seroma, and wound dehiscence, were compared. RESULTS: Before matching, ADM patients were more likely to have obesity, nicotine dependence, endocrine therapy with letrozole, chemotherapy, and radiation exposure (p<0.05). After matching, ADM use was associated with lower SSI but higher wound dehiscence. Outcomes differed by ADM type. ADM#3 was associated with lower risk of implant/TE removal, SSI, seroma, and wound dehiscence, while ADM#1 demonstrated lower implant/TE removal and SSI. ADM#2 outcomes were similar to no ADM. CONCLUSION: In this propensity-matched cohort, outcomes varied by ADM type, with sterile human ADM and aseptically processed human ADM in 70% ethanol demonstrating favorable complication profiles. Product-level differences of ADM may influence postoperative outcomes in breast reconstruction.