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Dueñas-Rodríguez B, Navarro-Cecilia J, Luque-López C, Sánchez-Andujar B, Garcelán-Trigo JA, Ramírez-Expósito MJ, Martínez-Martos JM. Single-Stage Immediate Breast Reconstruction with Acellular Dermal Matrix after Breast Cancer: Comparative Study and Evaluation of Breast Reconstruction Outcomes. Cancers (Basel) 2023; 15:5349. [PMID: 38001609 PMCID: PMC10670310 DOI: 10.3390/cancers15225349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
We evaluate postoperative complications, aesthetic results and satisfaction outcomes in patients with breast cancer after intervening with a skin-sparing or nipple-sparing mastectomy with an immediate prosthetic reconstruction with or without a biological mesh. Patients with multifocal breast cancer, ductal carcinoma in situ with an indication for a mastectomy and cT2 tumors with no response to primary systemic treatment were included, whereas patients aged >75 years, with inflammatory carcinoma, and severe circulatory disorders were excluded. Patients in the control group were reconstructed using a prosthesis, whereas the study group included patients reconstructed using a prosthesis and biological acellular porcine dermal mesh (Strattice™). In both groups, the result was assessed using the BREAST-Q instrument. A total of 51 patients (62 intervened breasts) were included in the study group and 38 patients (41 intervened breasts) in the control group. Implant loss and removal occurred in three patients in the study group (5.9%) and nine patients in the control group (24.3%; p = 0.030). Infections appeared in three patients in the study group (4.8%) and three patients in the control group (7.3%; p = 1.00). Skin necrosis appeared in 5 patients in the study group (12.2%) and 11 patients in the control group (21.6%; p = 0.367). Seroma appeared in five patients in the study group (12.2%) and five patients in the control group (8.1%; p = 0.514). The BREAST-Q questionnaire is a comparison between both groups regarding "satisfaction with breasts after surgery" (p = 0.026), "sexual well-being after intervention" (p = 0.010) and "satisfaction with the information received" (p = 0.049). We have noted a statistically significant decrease in implant loss in women receiving an implant with a biological mesh. A higher satisfaction was observed in patients reconstructed using Strattice™, with statistically significant differences in three items.
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Affiliation(s)
- Basilio Dueñas-Rodríguez
- Unit of Breast Pathology, Department of Surgery, Hospital Complex of Jaén, 23007 Jaén, Spain; (B.D.-R.); (J.N.-C.); (B.S.-A.)
| | - Joaquín Navarro-Cecilia
- Unit of Breast Pathology, Department of Surgery, Hospital Complex of Jaén, 23007 Jaén, Spain; (B.D.-R.); (J.N.-C.); (B.S.-A.)
| | - Carolina Luque-López
- Department of Gynecology and Obstetrics, Hospital Complex of Jaén, 23007 Jaén, Spain;
| | - Belén Sánchez-Andujar
- Unit of Breast Pathology, Department of Surgery, Hospital Complex of Jaén, 23007 Jaén, Spain; (B.D.-R.); (J.N.-C.); (B.S.-A.)
| | | | - María Jesús Ramírez-Expósito
- Experimental and Clinical Physiopathology Research Group CTS-1039, Department of Health Sciences, School of Experimental and Health Sciences, University of Jaén, 23071 Jaén, Spain;
| | - José Manuel Martínez-Martos
- Experimental and Clinical Physiopathology Research Group CTS-1039, Department of Health Sciences, School of Experimental and Health Sciences, University of Jaén, 23071 Jaén, Spain;
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Francis SD, Thawanyarat K, Johnstone TM, Yesantharao PS, Kim TS, Rowley MA, Sheckter CC, Nazerali RS. How Postoperative Infection Affects Reoperations after Implant-based Breast Reconstruction: A National Claims Analysis of Abandonment of Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5040. [PMID: 37325376 PMCID: PMC10263246 DOI: 10.1097/gox.0000000000005040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 06/17/2023]
Abstract
Infection after implant-based breast reconstruction adversely affects surgical outcomes and increases healthcare utilization. This study aimed to quantify how postimplant breast reconstruction infections impact unplanned reoperations, hospital length of stay, and discontinuation of initially desired breast reconstruction. Methods We conducted a retrospective cohort study using Optum's de-identifed Clinformatics Data Mart Database to analyze women undergoing implant breast reconstruction from 2003 to 2019. Unplanned reoperations were identified via Current Procedural Terminology (CPT) codes. Outcomes were analyzed via multivariate linear regression with Poisson distribution to determine statistical significance at P < 0.00625 (Bonferroni correction). Results In our national claims-based dataset, post-IBR infection rate was 8.53%. Subsequently, 31.2% patients had an implant removed, 6.9% had an implant replaced, 3.6% underwent autologous salvage, and 20.7% discontinued further reconstruction. Patients with a postoperative infection were significantly associated with increased incidence rate of total reoperations (IRR, 3.11; 95% CI, 2.92-3.31; P < 0.001) and total hospital length of stay (IRR, 1.55; 95% CI, 1.48-1.63; P < 0.001). Postoperative infections were associated with significantly increased odds of abandoning reconstruction (OR, 2.92; 95% CI, 0.081-0.11; P < 0.001). Conclusions Unplanned reoperations impact patients and healthcare systems. This national, claims-level study shows that post-IBR infection was associated with a 3.11× and 1.55× increase in the incidence rate of unplanned reoperations and length of stay. Post-IBR infection was associated with 2.92× increased odds of abandoning further reconstruction after implant removal.
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Affiliation(s)
| | - Kometh Thawanyarat
- Medical College of Georgia at Augusta University, AU/UGA Medical Partnership, Athens, Ga
| | | | - Pooja S Yesantharao
- Division of Plastic & Reconstructive Surgery, Stanford University School of Medicine, Palo Alto, Calif
| | | | - Mallory A Rowley
- State University of New York, Upstate Medical University, Syracuse, N.Y
| | - Clifford C Sheckter
- Division of Plastic & Reconstructive Surgery, Stanford University School of Medicine, Palo Alto, Calif
| | - Rahim S Nazerali
- Division of Plastic & Reconstructive Surgery, Stanford University School of Medicine, Palo Alto, Calif
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Gao P, Bai P, Ren Y, Kong X, Wang Z, Fang Y, Wang J. Biological Matrix-Assisted One-Stage Implant-Based Breast Reconstruction Versus Two-Stage Implant-Based Breast Reconstruction: Patient-Reported Outcomes and Complications. Aesthetic Plast Surg 2021; 45:2581-2590. [PMID: 34350500 DOI: 10.1007/s00266-021-02509-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/24/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Biological matrix-assisted one-stage implant-based breast reconstruction (IBBR) could improve the inframammary fold to achieve good esthetic results. However, whether biological matrix-assisted one-stage IBBR yields better postoperative outcomes compared with two-stage IBBR remains unclear. We aimed to compare and analyze surgical complications and patient-reported outcomes (PROs) based on the BREAST-Q version 2.0 questionnaire between biological matrix-assisted one-stage IBBR and traditional two-stage IBBR. METHODS From May 2015 to June 2019, eligible patients who underwent SIS matrix-assisted one-stage IBBR or two-stage IBBR were enrolled in this retrospective cohort study. PROs were measured with BREAST-Q version 2.0, which scored the health-related quality of life, satisfaction, and experience domains. Complications were divided into major complications (patients requiring reoperation) and minor complications (patients who could be treated in the dressing room). PROs and complications were compared between the SIS matrix-assisted one-stage IBBR and two-stage IBBR groups. A multivariate linear regression analysis was used to identify the social and surgical factors that affected PROs. RESULTS At our institution, 124 eligible patients were recruited. Seventy-nine patients (63.7%) underwent SIS matrix-assisted one-stage IBBR reconstruction, and 45 patients (36.3%) underwent tissue expander/implant reconstruction (two-stage IBBR). Postoperative BREAST-Q version 2.0 was completed by 68 of 79 patients (86.1%) in the SIS matrix-assisted one-stage IBBR group and by 35 of 45 patients (77.8%) in the two-stage IBBR group. In the satisfaction-related quality of life domain, satisfaction with breast was 9.27 points higher in the SIS matrix-assisted one-stage IBBR group (p = 0.012) compared with the two-stage IBBR group. The multivariate linear regression analysis showed that implant volume (p = 0.031) and postoperative radiotherapy (p = 0.036) significantly influenced the PRO of satisfaction with breast. However, patients in the SIS matrix-assisted one-stage IBBR group had a higher minor complication rate compared with patients in the two-stage IBBR group (p = 0.026). CONCLUSIONS Our retrospective study showed that although patients treated with biological matrix-assisted one-stage IBBR tended to have higher postoperative complication rates, this technique correlated with better PROs compared with two-stage IBBR. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Peng Gao
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Ping Bai
- Department of The Operating Room, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yinpeng Ren
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xiangyi Kong
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zhongzhao Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Yi Fang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Jing Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Kalstrup J, Balslev Willert C, Brinch-Møller Weitemeyer M, Hougaard Chakera A, Hölmich LR. Immediate direct-to-implant breast reconstruction with acellular dermal matrix: Evaluation of complications and safety. Breast 2021; 60:192-198. [PMID: 34688959 PMCID: PMC8551207 DOI: 10.1016/j.breast.2021.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Immediate direct-to-implant breast reconstruction with acellular dermal matrix (ADM) is the method of choice for many plastic surgeons and patients, but the use of ADM remains a controversial subject in the literature. This study aimed to investigate complications, reconstructive failure and possible risk factors in direct-to-implant breast reconstruction with ADM (primarily Strattice™). METHODS We retrospectively examined all patients undergoing immediate direct-to-implant breast reconstruction with ADM, during a five-year period (2014-2019) at a university clinic. Study outcomes were all complications and explantations. Complications were stratified within and after 6 months postoperatively and subcategorized by type of intervention. Explantations were subcategorized into loss of implant or salvage with immediate insertion of a tissue expander, the same or a new implant. RESULTS We included 154 patients and 232 breasts. Complications within 6 months per patient included hematoma (4%), seroma (8%), infection (9%), necrosis, wound dehiscence and delayed wound healing (19%). The total complication rate per patient was 34%. Explantation occurred in 20 patients (13%) of which 9 (6% of all) had implant loss. Preoperative radiotherapy was a significant predictor of explantation (adjusted OR 4.9, 95% confidence interval (CI), 1.0-23.5; p = 0.045), and smoking was also associated with risk of explantation, although only borderline significant (adjusted OR 4.0, 95% CI, 1.0-15.8; p = 0.050). CONCLUSION This study demonstrates acceptable rates of re-operations and implant loss compared to other studies but highlights the importance of proper patient selection with regards to risk factors to minimize complications.
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Affiliation(s)
- Julie Kalstrup
- Department of Plastic and Reconstructive Surgery, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| | - Cecilie Balslev Willert
- Department of Plastic and Reconstructive Surgery, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Marie Brinch-Møller Weitemeyer
- Department of Plastic and Reconstructive Surgery, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| | - Annette Hougaard Chakera
- Department of Plastic and Reconstructive Surgery, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Lisbet Rosenkrantz Hölmich
- Department of Plastic and Reconstructive Surgery, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark.
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Barber MD, Young O, Kulkarni D, Young I, Saleem TB, Fernandez T, Revie E, Dixon JM. No evidence of benefit for laminar flow in theatre for sling-assisted, implant-based breast reconstruction. Surgeon 2021; 19:e112-e116. [DOI: 10.1016/j.surge.2020.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/18/2020] [Accepted: 08/27/2020] [Indexed: 01/25/2023]
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Whisker L, Barber M, Egbeare D, Gandhi A, Gilmour A, Harvey J, Martin L, Tillett R, Potter S. Biological and synthetic mesh assisted breast reconstruction procedures: Joint guidelines from the Association of Breast Surgery and the British Association of Plastic, Reconstructive and Aesthetic Surgeons. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 47:2807-2813. [PMID: 34088587 DOI: 10.1016/j.ejso.2021.05.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/16/2021] [Accepted: 05/19/2021] [Indexed: 11/29/2022]
Abstract
These guidelines have been produced with the involvement of the Association of Breast Surgery and the British Association of Plastic, Reconstructive and Aesthetic Surgeons. Recommendations have been derived after a review of published data regarding the use of acellular dermal matrix (ADM), biological and synthetic mesh in breast reconstruction. The guidelines represent a consensus opinion on the optimal management of patients having biological or synthetic mesh assisted breast reconstruction informed by peer-review publications. The Guidelines should be used to inform clinical decision making. Ultimately, members of the MDT remain responsible for the treatment of patients under their care.
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Affiliation(s)
- Lisa Whisker
- Nottingham Breast Institute, City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK.
| | - Matthew Barber
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, EH4 2XU, Scotland, UK.
| | - Donna Egbeare
- The Breast Centre, Cardiff and the Vale University Health Board, UK.
| | - Ashu Gandhi
- The Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, M23 9LT, UK; Manchester Academic Health Sciences Centre, Manchester, UK.
| | - Adam Gilmour
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Scotland, UK.
| | - James Harvey
- The Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, M23 9LT, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK.
| | - Lee Martin
- Liverpool Breast Unit, Liverpool University Foundation Trust, UK.
| | | | - Shelley Potter
- Population Health Sciences, Bristol Medical School and Bristol Breast Care Centre, North Bristol NHS Trust, UK.
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Gao P, Wang Z, Kong X, Wang X, Fang Y, Wang J. Comparisons of Therapeutic and Aesthetic Effects of One-Stage Implant-Based Breast Reconstruction with and without Biological Matrix. Cancer Manag Res 2020; 12:13381-13392. [PMID: 33402848 PMCID: PMC7778507 DOI: 10.2147/cmar.s282442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/02/2020] [Indexed: 11/24/2022] Open
Abstract
Background Biological matrix can provide coverage of compromised muscle and augment the subpectoral pocket in the one-stage reconstruction. However, few studies compared one stage implant-based breast reconstruction with and without biological matrix. The primary endpoint of our study was to assess the patient-reported outcomes (PROs) based on BREAST-Q version 2.0 and analyze complications between SIS matrix-assisted implant-based breast reconstruction (IBBR) and no-matrix-assisted IBBR. Methods This retrospective single-center study was conducted from May 2015 to April 2019, and we analyzed 155 patients who underwent one-stage IBBR with at least 1 year of follow-up. Seventy-nine patients underwent one-stage IBBR with SIS matrix group and 76 patients underwent one-stage IBBR without SIS matrix group were evaluated of PROs with BREAST-Q version 2.0 (from 3 different domains) and compared with complications. Complications occurred in patients were divided into major complications and minor complications. Results In the satisfaction domain, the mean score for satisfaction with breasts was 60.27 (17.71) in the SIS matrix group and 54.49 (14.76) in the no-matrix group, p=0.045. The multivariate logistic regression for postoperative complications in the whole series pointed out a statistical significance for age>40 years old (odds ratio 3.314, 95% CI 1.012–10.854, p=0.048) and patients with endocrine therapy (odds ratio 0.260, 95% CI 0.092–0.736, p=0.011). Conclusion Patients who underwent SIS matrix-assisted one-stage IBBR yield better results in PROs of satisfaction with breasts. Other domains and complications between the two groups had no significant difference.
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Affiliation(s)
- Peng Gao
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People's Republic of China
| | - Zhongzhao Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People's Republic of China
| | - Xiangyi Kong
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People's Republic of China
| | - Xiangyu Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People's Republic of China
| | - Yi Fang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People's Republic of China
| | - Jing Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People's Republic of China
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Robertson BF, Campbell EJ, Armstrong M, Malyon A. Reconstructive trends following mastectomies in Scotland: A comparison with England. Surgeon 2020; 19:212-218. [PMID: 32839117 DOI: 10.1016/j.surge.2020.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/29/2020] [Accepted: 07/23/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In England there has been a substantial increase in the use of immediate implant-based reconstruction, accounting for over half of all immediate reconstructions (IR). Less than one third of patients in England undergo autologous reconstruction IR. Our aim was to examine IR trends in Scotland. METHODS Data was extracted from the Scottish Morbidity Record held at the Information Services Division of the NHS National Services Scotland. All patients discharged from Scottish hospitals between 2011 and 2016 who had a diagnosis of breast cancer including DCIS and underwent mastectomy were identified. Patients undergoing IR were identified by coding at the time of mastectomy to identify who had IR and what method was used. RESULTS Between 2011 and 2016, 7358 patients underwent a mastectomy for breast cancer. 1845 patients (25%) had an IR. The percentage of patients undergoing IR increased from 22% in 2011 to 26% in 2016. The dominant annual procedure type was autologous reconstruction (free flap and pedicled flaps), accounting for 58% in 2011 and 54% in 2016. Pedicled flaps alone decreased from 40% in 2011 to 28% in 2016 and free flaps increased from 18% in 2011 to 26% in 2016. Implant based reconstruction rates were broadly consistent, 37% in both 2011 and 2016. Pedicled flaps with implant reconstruction decreased from 13% in 2011 to 5% in 2016. CONCLUSIONS Autologous reconstruction (with increasing trend for free flaps procedures) remains a constant preferred technique for IR in Scotland, accounting for over half of IR performed.
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Affiliation(s)
| | | | - Matthew Armstrong
- Information Services Department, National Services for Scotland (NHS), United Kingdom
| | - Andrew Malyon
- Canniesburn Plastic Surgery Department, Glasgow Royal Infirmary, United Kingdom
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Quinn EM, Barry M, Kell M. Immediate implant reconstruction using absorbable TIGR mesh after nipple-sparing mastectomy. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-019-01603-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nam SY, Youn D, Kim GH, Chai JH, Lim HR, Jung HH, Heo CY. In Vitro Characterization of a Novel Human Acellular Dermal Matrix (BellaCell HD) for Breast Reconstruction. Bioengineering (Basel) 2020; 7:bioengineering7020039. [PMID: 32353944 PMCID: PMC7356368 DOI: 10.3390/bioengineering7020039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/24/2020] [Accepted: 04/26/2020] [Indexed: 11/16/2022] Open
Abstract
In the past, acellular dermal matrices (ADMs) have been used in implant-based breast reconstruction. Various factors affect the clinical performance of ADMs since there is a lack of systematic characterization of ADM tissues. This study used BellaCell HD and compared it to two commercially available ADMs—AlloDerm Ready to Use (RTU) and DermACELL—under in vitro settings. Every ADM was characterized to examine compatibility through cell cytotoxicity, proliferation, and physical features like tensile strength, stiffness, and the suture tensile strength. The BellaCell HD displayed complete decellularization in comparison with the other two ADMs. Several fibroblasts grew in the BellaCell HD with no cytotoxicity. The proliferation level of fibroblasts in the BellaCell HD was higher, compared to the AlloDerm RTU and DermACELL, after 7 and 14 days. The BellaCell HD had a load value of 444.94 N, 22.44 tensile strength, and 118.41% elongation ratio, and they were higher than in the other two ADMs. There was no significant discrepancy in the findings of stiffness evaluation and suture retention strength test. The study had some limitations because there were many other more factors useful in ADM’s testing. In the study, BellaCell HD showed complete decellularization, high biocompatibility, low cytotoxicity, high tensile strength, high elongation, and high suture retention strengths. These characteristics make BellaCell HD a suitable tissue for adequate and safe use in implant-based breast reconstruction in humans.
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Affiliation(s)
- Sun-Young Nam
- Department of Plastic & Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (S.-Y.N.); (D.Y.)
| | - Dayoung Youn
- Department of Plastic & Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (S.-Y.N.); (D.Y.)
| | - Gyeong Hoe Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea;
| | - Ji Hwa Chai
- The Institute of Tissue Engineering, HansBiomed Co. LTD., Daejeon 34054, Korea; (J.H.C.); (H.R.L.); (H.H.J.)
| | - Hyang Ran Lim
- The Institute of Tissue Engineering, HansBiomed Co. LTD., Daejeon 34054, Korea; (J.H.C.); (H.R.L.); (H.H.J.)
| | - Hong Hee Jung
- The Institute of Tissue Engineering, HansBiomed Co. LTD., Daejeon 34054, Korea; (J.H.C.); (H.R.L.); (H.H.J.)
| | - Chan Yeong Heo
- Department of Plastic & Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (S.-Y.N.); (D.Y.)
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea;
- Correspondence: or
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Significantly reducing implant loss rates in immediate implant-based breast reconstruction: A protocol and completed audit of quality assurance. J Plast Reconstr Aesthet Surg 2019; 73:1043-1049. [PMID: 32008945 DOI: 10.1016/j.bjps.2019.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/14/2019] [Accepted: 12/13/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Immediate implant-based breast reconstruction (IBR) rates have increased considerably with the advent of acellular dermal matrices. Implant loss is a significant complication and is costly to patients and the NHS. National Mastectomy and Breast Reconstruction Audit and Implant-Based Breast Reconstruction Audit data have demonstrated national implant loss rate of 9% at 3 months. National Oncoplastic Guidelines for Best Practice cite a < 5% target. We aimed to reduce implant loss by introducing a protocol with pre-, intra- and post-operative interventions. METHODS Audit of IBR at a single oncoplastic breast unit was commenced and implant loss at 3 months was recorded (May 2012-July 2014). Patients were identified from a prospectively maintained database, and case notes were examined by identifying factors associated with implant loss. A team involving microbiology, theatre staff, infection control and surgeons was established. A novel, evidence-based intervention bundle, including more than 25 protocol changes, was introduced. Prospective re-audit of IBR (April 2015-December 2017) was completed following introduction of the new protocol and implant loss was recorded at 3 months. RESULTS The first retrospective audit of 77 reconstructions (54 patients) demonstrated 11 implant losses at 3 months (14%). Re-audit, post-intervention, comprised 129 reconstructions (106 patients) with no implant loss at 3 months. Fisher's exact analysis revealed statistically significant reduction in implant loss rate (P < 0.00001) following protocol introduction. CONCLUSIONS Implant loss rate following IBR can be reduced to an exceptionally low level, well below national targets, by adhering to this evidence-based intervention bundle. Our protocol could improve outcomes nationally.
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Chandarana M, Harries S. Multicentre study of prepectoral breast reconstruction using acellular dermal matrix. BJS Open 2019; 4:71-77. [PMID: 32011819 PMCID: PMC6996627 DOI: 10.1002/bjs5.50236] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 10/03/2019] [Indexed: 11/30/2022] Open
Abstract
Background Single‐stage reconstruction is used widely after mastectomy. Prepectoral implant placement is a relatively new technique. This multicentre audit examined surgical outcomes following prepectoral reconstruction using acellular dermal matrix (ADM). Methods All patients who had a mastectomy with prepectoral breast reconstruction and ADM in the participating centres between January 2015 and December 2017 were included. Demographic and treatment details, and short‐ and long‐term operative outcomes were recorded. Factors affecting complications and implant loss were analysed: age, BMI, smoking status, diabetes, vascular disease, laterality of surgery, previous ipsilateral breast surgery or radiotherapy, indication for surgery (invasive versus in situ carcinoma, or risk reduction), type of mastectomy, axillary clearance, breast volume, implant volume, and neoadjuvant and adjuvant chemotherapy. Results A total of 406 reconstructions were performed across 18 centres. Median follow‐up was 9·65 months. Median hospital stay was 1 day. The 90‐day unplanned readmission rate was 15·7 per cent, and the return‐to‐theatre rate 16·7 per cent. Some 15·3 per cent of patients had a major complication, with a 90‐day implant loss rate of 4·9 per cent. A further six patients had delayed implant loss. In multivariable analysis, no factor was significantly associated with complications or implant loss. Conclusion Prepectoral breast reconstruction with ADM has satisfactory surgical outcomes. The duration of follow‐up needs to be extended to examine outcomes in patients who received adjuvant radiotherapy.
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Affiliation(s)
- M Chandarana
- Department of General Surgery, Forth Valley Royal Hospital, Larbert, UK
| | - S Harries
- Department of Breast Surgery, Warwick Hospital, South Warwickshire NHS Foundation Trust, Warwick, UK
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Bing Z, Feng L, Wu CS, Du JT, Liu YF, Liu SX. Acellular dermal matrix contributes to epithelialization in patients with chronic sinusitis. J Biomater Appl 2019; 33:1053-1059. [PMID: 30651053 DOI: 10.1177/0885328218822636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Nasal endoscopic surgery is widely used for nasal diseases, including sinusitis and tumors. However, scar hyperplasia, nasal irritation, scab, and nasal obstruction delay nasal mucosal recovery, with prolonged cleaning exacerbating the patient's financial burden. Here, we presented a novel approach for the treatment of nasal mucosal defects, termed acellular dermal matrix. METHODS A total of 31 patients with bilateral chronic sinusitis (maxillary sinusitis and ethmoid sinusitis) underwent nasal surgery and nasal mucosal repair in September-October 2016. We divided the nasal cavities of each patient into control and acellular dermal matrix groups, randomly selected one side for nasal mucosal repair by surgery. A suitable acellular dermal matrix size was selected according to the defect in each patient. After pruning, the acellular dermal matrix was placed on the wound surface and filled with gelatin sponge. All patients were followed up for 14 weeks to compare nasal mucosal epithelialization between the control and acellular dermal matrix groups. Results:No obvious complications and adverse reactions were observed after nasal surgery. Lund-Kennedy scores in the acellular dermal matrix group were significantly decreased compared with the control group at 8 (0 (0, 1) vs. 2 (2, 4); P<0.05) weeks. Epithelialization time of eight weeks in the acellular dermal matrix groups was significantly decreased than the control group of 14 weeks. CONCLUSION Acellular dermal matrix provides a growth framework for the healthy mucosa on the wounded surface and reduces postoperative epithelialization time.
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Affiliation(s)
- Zhong Bing
- Sichuan University, West China Hospital, Department of Otolaryngology Head and Neck Surgery, Chengdu, Sichuan, China
| | - Liu Feng
- Sichuan University, West China Hospital, Department of Otolaryngology Head and Neck Surgery, Chengdu, Sichuan, China
| | - Chun-Shu Wu
- Sichuan University, West China Hospital, Department of Otolaryngology Head and Neck Surgery, Chengdu, Sichuan, China
| | - Jin-Tao Du
- Sichuan University, West China Hospital, Department of Otolaryngology Head and Neck Surgery, Chengdu, Sichuan, China
| | - Ya-Feng Liu
- Sichuan University, West China Hospital, Department of Otolaryngology Head and Neck Surgery, Chengdu, Sichuan, China
| | - Shi-Xi Liu
- Sichuan University, West China Hospital, Department of Otolaryngology Head and Neck Surgery, Chengdu, Sichuan, China
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Koppiker CB, Noor AU, Dixit S, Mahajan R, Sharan G, Dhar U, Busheri L, Nare S. Implant-Based Breast Reconstruction with Autologous Lower Dermal Sling and Radiation Therapy Outcomes. Indian J Surg 2019. [DOI: 10.1007/s12262-018-1856-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Hillberg NS, Ferdinandus PI, Dikmans REG, Winkens B, Hommes J, van der Hulst RRWJ. Is single-stage implant-based breast reconstruction (SSBR) with an acellular matrix safe?: Strattice™ or Meso Biomatrix® in SSBR. EUROPEAN JOURNAL OF PLASTIC SURGERY 2018; 41:429-438. [PMID: 30100676 PMCID: PMC6061485 DOI: 10.1007/s00238-018-1415-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/27/2018] [Indexed: 11/28/2022]
Abstract
Background Acellular matrices (AM) might enable a direct single-stage breast reconstruction procedure resulting in an improved efficacy of the reconstruction phase for patients. Safety concerns are an important issue due to a recent study which shows that single-stage breast reconstruction with Strattice™ resulted in more complications versus a two-stage reconstruction. Therefore, the goal of this study is to compare the short- and long-term complications of a single-stage breast reconstruction with the use of two types of AM (Strattice™ and Meso Biomatrix®) versus two-stage breast reconstruction without the use of an AM. Methods Cohort study with single-stage breast reconstruction with Strattice™ (n = 28) or Meso BioMatrix® (n = 20) or two-stage breast reconstruction without an AM (n = 36) at the Maastricht Academic Hospital, the Netherlands. All complications, in particular major complications with the need for re-admission to the hospital, re-exploration, and implant explantation, were the primary outcome measures. A 1-year follow-up was achieved for all patients. Results Baseline characteristics of all 52 patients were similar between groups. There was a significantly higher complication rate in the single-stage AM groups with loss of the implant in 40.0% of the breasts from the Meso BioMatrix® group and in 10.7% of the Strattice™ group compared to no implant loss in the control group. Conclusions This cohort study clearly suggests that the use of a single-stage breast reconstruction is not safe with the use of these AMs. Well-designed prospective studies that guarantee the safety of those matrices should be published before these AMs are used in implant-based surgery. Level of Evidence: Level III, risk / prognostic study.
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Affiliation(s)
- Nadine S Hillberg
- 1Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Patrick I Ferdinandus
- 1Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Rieky E G Dikmans
- 2Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, the Netherlands
| | - Bjorn Winkens
- 3Department of Methodology and Statistics, CAPHRI School for Public Health and Primary Care, Faculty of Health Medicine and Life Science, Maastricht, The Netherlands
| | - Juliette Hommes
- 1Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - René R W J van der Hulst
- 1Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
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A Meta-analysis of Studies Comparing Outcomes of Diverse Acellular Dermal Matrices for Implant-Based Breast Reconstruction. Ann Plast Surg 2018; 79:115-123. [PMID: 28509698 DOI: 10.1097/sap.0000000000001085] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The current diversity of the available acellular dermal matrix (ADM) materials for implant-based breast reconstruction raises the issue of whether there are any differences in postoperative outcomes according to the kind of ADM used. The present meta-analysis aimed to investigate whether choice of ADM products can affect outcomes. METHODS Studies that used multiple kinds of ADM products for implant-based breast reconstruction and compared outcomes between them were searched. Outcomes of interest were rates of postoperative complications: infection, seroma, mastectomy flap necrosis, reconstruction failure, and overall complications. RESULTS A total of 17 studies met the selection criteria. There was only 1 randomized controlled trial, and the other 16 studies had retrospective designs. Comparison of FlexHD, DermaMatrix, and ready-to-use AlloDerm with freeze-dried AlloDerm was conducted in multiple studies and could be meta-analyzed, in which 12 studies participated. In the meta-analysis comparing FlexHD and freeze-dried AlloDerm, using the results of 6 studies, both products showed similar pooled risks for all kinds of complications. When comparing DermaMatrix and freeze-dried AlloDerm with the results from 4 studies, there were also no differences between the pooled risks of complications of the two. Similarly, the meta-analysis of 4 studies comparing ready-to-use and freeze-dried AlloDerm demonstrated that the pooled risks for the complications did not differ. CONCLUSIONS This meta-analysis demonstrates that the 3 recently invented, human cadaveric skin-based products of FlexHD, DermaMatrix, and ready-to-use AlloDerm have similar risks of complications compared with those of freeze-dried AlloDerm, which has been used for longer. However, as most studies had low levels of evidence, further investigations are needed.
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Evaluation of Acellular Dermal Matrix Efficacy in Prosthesis-Based Breast Reconstruction. Plast Reconstr Surg 2018; 141:541-549. [DOI: 10.1097/prs.0000000000004109] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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A single-centre, retrospective proof-of-concept review of salvage of infected or exposed implant breast reconstructions with explantation and one-stage free flap replacement. J Plast Reconstr Aesthet Surg 2018; 71:194-200. [DOI: 10.1016/j.bjps.2017.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/13/2017] [Accepted: 10/04/2017] [Indexed: 11/23/2022]
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The Comparison of Strattice and SurgiMend in Acellular Dermal Matrix–Assisted, Implant-Based Immediate Breast Reconstruction. Plast Reconstr Surg 2018; 141:283-293. [DOI: 10.1097/prs.0000000000004018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mazari FAK, Asgeirsson KS, Whisker L, Gutteridge E, Rasheed T, Douglas Macmillan R. Complete resorption of Veritas® in acellular dermal matrix (ADM)-assisted implant-based breast reconstructions—is there a need for tighter regulation of new products developed for use in breast reconstruction? EUROPEAN JOURNAL OF PLASTIC SURGERY 2018. [DOI: 10.1007/s00238-017-1389-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hallberg H, Rafnsdottir S, Selvaggi G, Strandell A, Samuelsson O, Stadig I, Svanberg T, Hansson E, Lewin R. Benefits and risks with acellular dermal matrix (ADM) and mesh support in immediate breast reconstruction: a systematic review and meta-analysis. J Plast Surg Hand Surg 2018; 52:130-147. [PMID: 29320921 DOI: 10.1080/2000656x.2017.1419141] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In modern implant-based immediate breast reconstruction, it has become common to use biological acellular dermal and synthetic matrices in combination with a tissue expander or an implant. The aim of this systematic review was to examine differences in recurrence of cancer, impact on oncological treatment, health related quality of life, complications and aesthetic outcome between matrix and no matrix in immediate breast reconstruction. Systematic searches, data extraction and assessment of methodological quality were performed according to predetermined criteria. Fifty-one studies were eligible and included in the review. The certainty of evidence for overall complication rate and implant loss is low (GRADE ⊕⊕□ □). The certainty of evidence for delay of adjuvant treatment, implant loss, infection, capsular contraction and aesthetic outcome is very low (GRADE ⊕□ □ □). No study reported data on recurrence of cancer or health related quality of life. In conclusion, there is a lack of high quality studies that compare the use of matrix with no matrix in immediate breast reconstruction. Specifically, there are no data on risk of recurrence of cancer, delay of adjuvant treatment and Health related quality of life (HRQoL). In addition, there is a risk of bias in many studies. It is often unclear what complications have been included and how they have been diagnosed, and how and when capsular contracture and aesthetic outcome have been evaluated. Controlled trials that further analyse the impact of radiotherapy, type of matrix and type of procedure (one or two stages) are necessary.
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Affiliation(s)
- Håkan Hallberg
- a Department of clinical sciences , University of Gothenburg, The Sahlgrenska Academy , Gothenburg , Sweden.,b Department of Reconstructive Plastic Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Svanheidur Rafnsdottir
- a Department of clinical sciences , University of Gothenburg, The Sahlgrenska Academy , Gothenburg , Sweden.,c Department of Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Gennaro Selvaggi
- a Department of clinical sciences , University of Gothenburg, The Sahlgrenska Academy , Gothenburg , Sweden.,b Department of Reconstructive Plastic Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Annika Strandell
- d Health Technology Assessment centre , Region Västra Götaland , Gothenburg , Sweden
| | - Ola Samuelsson
- d Health Technology Assessment centre , Region Västra Götaland , Gothenburg , Sweden
| | - Ida Stadig
- e Medical Library , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Therese Svanberg
- d Health Technology Assessment centre , Region Västra Götaland , Gothenburg , Sweden
| | - Emma Hansson
- a Department of clinical sciences , University of Gothenburg, The Sahlgrenska Academy , Gothenburg , Sweden.,b Department of Reconstructive Plastic Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Richard Lewin
- a Department of clinical sciences , University of Gothenburg, The Sahlgrenska Academy , Gothenburg , Sweden.,b Department of Reconstructive Plastic Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden
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A direct comparison of porcine (Strattice™) and bovine (Surgimend™) acellular dermal matrices in implant-based immediate breast reconstruction. J Plast Reconstr Aesthet Surg 2017. [DOI: 10.1016/j.bjps.2017.05.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Mylvaganam S, Conroy E, Williamson PR, Barnes NLP, Cutress RI, Gardiner MD, Jain A, Skillman JM, Thrush S, Whisker LJ, Blazeby JM, Potter S, Holcombe C. Variation in the provision and practice of implant-based breast reconstruction in the UK: Results from the iBRA national practice questionnaire. Breast 2017; 35:182-190. [PMID: 28768227 PMCID: PMC5590633 DOI: 10.1016/j.breast.2017.07.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 07/19/2017] [Accepted: 07/24/2017] [Indexed: 11/30/2022] Open
Abstract
Introduction The introduction of biological and synthetic meshes has revolutionised the practice of implant-based breast reconstruction (IBBR) but evidence for effectiveness is lacking. The iBRA (implant Breast Reconstruction evAluation) study is a national trainee-led project that aims to explore the practice and outcomes of IBBR to inform the design of a future trial. We report the results of the iBRA National Practice Questionnaire (NPQ) which aimed to comprehensively describe the provision and practice of IBBR across the UK. Methods A questionnaire investigating local practice and service provision of IBBR developed by the iBRA Steering Group was completed by trainee and consultant leads at breast and plastic surgical units across the UK. Summary data for each survey item were calculated and variation between centres and overall provision of care examined. Results 81 units within 79 NHS-hospitals completed the questionnaire. Units offered a range of reconstructive techniques, with IBBR accounting for 70% (IQR:50–80%) of participating units' immediate procedures. Units on average were staffed by 2.5 breast surgeons (IQR:2.0–3.0) and 2.0 plastic surgeons (IQR:1.0–3.0) performing 35 IBBR cases per year (IQR:20-50). Variation was demonstrated in the provision of novel different techniques for IBBR especially the use of biological (n = 62) and synthetic (n = 25) meshes and in patient selection for these procedures. Conclusions The iBRA-NPQ has demonstrated marked variation in the provision and practice of IBBR in the UK. The prospective audit phase of the iBRA study will determine the safety and effectiveness of different approaches to IBBR and allow evidence-based best practice to be explored. Implant breast reconstruction (IBBR) and the range of techniques is poorly evidence based. We aimed to explore the current practice of IBBR in the UK to inform the design of a future definitive study. Significant variation was demonstrated in the availability of techniques and patient selection for IBBR. There is a need for well-designed studies to establish best practice and improve outcomes for patients considering IBBR.
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Affiliation(s)
- Senthurun Mylvaganam
- New Cross Hospital, Royal Wolverhampton Hospitals NHS Trust, Wednesfield Way, Wolverhampton, WV10 0QP, UK
| | - Elizabeth Conroy
- Clinical Trials Research Centre (CTRC), North West Hub for Trials Methodology/University of Liverpool, Liverpool, L12 2AP, UK
| | - Paula R Williamson
- Clinical Trials Research Centre (CTRC), North West Hub for Trials Methodology/University of Liverpool, Liverpool, L12 2AP, UK
| | - Nicola L P Barnes
- Breast Unit, University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK
| | - Ramsey I Cutress
- Breast Unit, University Hospital Southampton, Tremona Road, Southampton, Hampshire, SO16 6YD, UK; Faculty of Medicine, Cancer Sciences Unit, University of Southampton, Somers Cancer Research Building, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Matthew D Gardiner
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7HE, UK; Department of Plastic Surgery, Imperial College London NHS Trust, London, SW7 2AZ, UK
| | - Abhilash Jain
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7HE, UK; Department of Plastic Surgery, Imperial College London NHS Trust, London, SW7 2AZ, UK
| | - Joanna M Skillman
- Department of Plastic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Steven Thrush
- Breast Unit, Worcester Royal Hospital, Charles Hastings Way, Worcester, WR5 1DD, UK
| | - Lisa J Whisker
- Breast Institute, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham, NG5 1PB, UK
| | - Jane M Blazeby
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Clifton, Bristol, BS8 2PS, UK
| | - Shelley Potter
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Clifton, Bristol, BS8 2PS, UK; Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital, Prescot Street, Liverpool, L7 8XP, UK.
| | - Christopher Holcombe
- Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital, Prescot Street, Liverpool, L7 8XP, UK
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Robertson SA, Jeevaratnam JA, Agrawal A, Cutress RI. Mastectomy skin flap necrosis: challenges and solutions. BREAST CANCER-TARGETS AND THERAPY 2017; 9:141-152. [PMID: 28331365 PMCID: PMC5357072 DOI: 10.2147/bctt.s81712] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction Mastectomy skin flap necrosis (MSFN) has a reported incidence of 5%–30% in the literature. It is often a significant and underappreciated problem. The aim of this article was to review the associated challenges and possible solutions. Methods A MEDLINE search was performed using the search term “mastectomy skin flap necrosis”. Titles and abstracts from peer-reviewed publications were screened for relevance. Results MSFN is a common complication and may present as partial- or full-thickness necrosis. Predictive patient risk factors include smoking, diabetes, obesity, radiotherapy, previous scars and severe medical comorbidity. MSFN leads to a number of challenges, including wound management problems, delays to adjuvant therapy, esthetic compromise, implant extrusion, patient distress and financial loss. Careful preoperative planning and meticulous surgical technique may reduce the incidence of MSFN. A number of intraoperative techniques are available to try and predict skin flaps at risk of MSFN. MSFN may be managed operatively or nonoperatively. Early intervention may reduce the morbidity of MSFN in selected cases. Topical nitroglycerin ointment may be beneficial in reducing MSFN following immediate reconstruction, but the evidence base is still limited. Conclusion MSFN can result in considerable challenges for the patient and the health care service. This review discusses the management options for this problem.
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Affiliation(s)
- Stuart A Robertson
- Department of Surgery, University Hospital Coventry and Warwickshire NHS Trust, Coventry
| | - Johann A Jeevaratnam
- Department of Breast Surgery, Portsmouth Hospitals NHS Trust, Cosham, Portsmouth
| | - Avi Agrawal
- Department of Breast Surgery, Portsmouth Hospitals NHS Trust, Cosham, Portsmouth
| | - Ramsey I Cutress
- Department of Breast Surgery, University Hospital Southampton NHS Foundation Trust, Princess Anne Hospital; Somers Cancer Research UK Centre, Southampton General Hospital Southampton, UK
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Knabben L, Kanagalingam G, Imboden S, Günthert AR. Acellular Dermal Matrix (Permacol ®) for Heterologous Immediate Breast Reconstruction after Skin-Sparing Mastectomy in Patients with Breast Cancer: A Single-Institution Experience and a Review of the Literature. Front Med (Lausanne) 2017; 3:72. [PMID: 28105410 PMCID: PMC5213735 DOI: 10.3389/fmed.2016.00072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 12/16/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Skin-sparing mastectomy (SSM) with immediate heterologous reconstruction is a safe oncological option in surgical therapy of early breast cancer. Permacol® is an acellular dermal matrix (ADM) placed between the implant and the skin to improve lower pole projection and implant coverage. The aim of our study was to evaluate the outcome with a focus on patient satisfaction after 6 months and to analyze physical changes of ADM. METHODS 10 patients who underwent SSM with Permacol® were analyzed retrospectively. All patients were followed using a satisfaction questionnaire and an ultrasound evaluation of the tissue thickness of the pectoralis muscle and the Permacol®. RESULTS No intraoperative complications were observed. One patient required removal of the implant for necrosis after 3 months. Half of the patients underwent secondary corrective surgery. A statistically significant thinning of the pectoralis muscle was observed, compared to the thickening of the Permacol®. A majority of the patients were satisfied with the operation, and we found a correlation between lower body mass index and patient satisfaction. CONCLUSION In our small case series Permacol®-assisted immediate reconstruction is shown to be an option for selected cases. Physical changes of Permacol® result in a symmetrical coverage of the implant, which may improve cosmetic outcome.
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Affiliation(s)
- Laura Knabben
- Department of Obstetrics and Gynaecology, University Hospital of Berne, University of Berne , Berne , Switzerland
| | - Gowthami Kanagalingam
- Department of Obstetrics and Gynaecology, University Hospital of Berne, University of Berne , Berne , Switzerland
| | - Sara Imboden
- Department of Obstetrics and Gynaecology, University Hospital of Berne, University of Berne , Berne , Switzerland
| | - Andreas R Günthert
- Department of Obstetrics and Gynaecology, Cantonal Hospital of Lucerne , Lucerne , Switzerland
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Complication Rates With Human Acellular Dermal Matrices: Retrospective Review of 211 Consecutive Breast Reconstructions. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e1118. [PMID: 27975023 PMCID: PMC5142489 DOI: 10.1097/gox.0000000000001118] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 09/13/2016] [Indexed: 11/25/2022]
Abstract
Background: Human acellular dermal matrix (HADM) is commonly used to provide coverage and support for breast reconstruction. The primary purpose of this study was to evaluate the complication rates associated with breast reconstruction procedures when performed in conjunction with multiple types of HADM in a consecutive series. Methods: After receiving institutional review board approval, medical records from a single surgeon were retrospectively reviewed for 126 consecutive patients (170 breasts and 211 procedures) who received a breast reconstruction or revision with implantation of HADM between 2012 and 2014. Patient demographics, surgical technique, and the complication profile of 4 major types of HADM were evaluated by procedure. Complication data were primarily evaluated for infection, seroma formation, necrosis, and other complications requiring additional surgery. Results: The total complication rate was 19.4%. The complication rates were not statistically different between all 4 types of HADM: Alloderm (n = 143); Alloderm RTU (n = 19); FlexHD (n = 18); hMatrix (n = 32) (P > 0.05). Smokers and large-breasted women (≥500 g) had a significantly higher complication rate than the rest of the population (P < 0.01 and P < 0.03, respectively). The complication rates associated with all other patient cohorts analyzed (age, body mass index, comorbid conditions, cancer diagnosis, prepectoral technique) showed no influence on complication rates (P > 0.05). Conclusions: In characteristically similar cohorts, there was no statistically significant difference in complication rates based on type of HADM; however, certain risk factors and anatomy should be considered before HADM-assisted breast reconstruction.
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Dave R, O'Connell R, Rattay T, Tolkien Z, Barnes N, Skillman J, Williamson P, Conroy E, Gardiner M, Harnett A, O'Brien C, Blazeby J, Potter S, Holcombe C. The iBRA-2 (immediate breast reconstruction and adjuvant therapy audit) study: protocol for a prospective national multicentre cohort study to evaluate the impact of immediate breast reconstruction on the delivery of adjuvant therapy. BMJ Open 2016; 6:e012678. [PMID: 27855106 PMCID: PMC5073644 DOI: 10.1136/bmjopen-2016-012678] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Immediate breast reconstruction (IBR) is routinely offered to improve quality of life for women with breast cancer requiring a mastectomy, but there are concerns that more complex surgery may delay the delivery of adjuvant oncological treatments and compromise long-term oncological outcomes. High-quality evidence, however, is lacking. iBRA-2 is a national prospective multicentre cohort study that aims to investigate the effect of IBR on the delivery of adjuvant therapy. METHODS AND ANALYSIS Breast and plastic surgery centres in the UK performing mastectomy with or without (±) IBR will be invited to participate in the study through the trainee research collaborative network. All women undergoing mastectomy ± IBR for breast cancer between 1 July and 31 December 2016 will be included. Patient demographics, operative, oncological and complication data will be collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR will be compared to determine the impact that IBR has on the time of delivery of adjuvant therapy. Prospective data on 3000 patients from ∼50 centres are anticipated. ETHICS AND DISSEMINATION Research ethics approval is not required for this study. This has been confirmed using the online Health Research Authority decision tool. This novel study will explore whether IBR impacts the time to delivery of adjuvant therapy. The study will provide valuable information to help patients and surgeons make more informed decisions about their surgical options. Dissemination of the study protocol will be via the Mammary Fold Academic and Research Collaborative (MFAC) and the Reconstructive Surgery Trials Network (RSTN), the Association of Breast Surgery (ABS) and the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS). Participating units will have access to their own data and collective results will be presented at relevant surgical conferences and published in appropriate peer-reviewed journals.
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Affiliation(s)
- Rajiv Dave
- Nightingale Breast Unit, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Rachel O'Connell
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Tim Rattay
- Department of Cancer Studies, Clinical Sciences Building, University of Leicester, Leicester, UK
| | - Zoe Tolkien
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Nicola Barnes
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Joanna Skillman
- Department of Plastic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Paula Williamson
- Department of Biostatistics, Clinical Trials Research Centre, University of Liverpool MRC North West Hub for Trials Methodology Research, University of Liverpool, Liverpool, UK
| | - Elizabeth Conroy
- Department of Biostatistics, Clinical Trials Research Centre, University of Liverpool MRC North West Hub for Trials Methodology Research, University of Liverpool, Liverpool, UK
| | - Matthew Gardiner
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | | | - Jane Blazeby
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Shelley Potter
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Chris Holcombe
- Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital, Liverpool, UK
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Sharma S, Van Barsel S, Barry M, Kell MR. De novo experience of resorbable woven mesh in immediate breast reconstruction post-mastectomy. EUROPEAN JOURNAL OF PLASTIC SURGERY 2016. [DOI: 10.1007/s00238-016-1227-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Potter S, Conroy EJ, Williamson PR, Thrush S, Whisker LJ, Skillman JM, Barnes NLP, Cutress RI, Teasdale EM, Mills N, Mylvaganam S, Branford OA, McEvoy K, Jain A, Gardiner MD, Blazeby JM, Holcombe C. The iBRA (implant breast reconstruction evaluation) study: protocol for a prospective multi-centre cohort study to inform the feasibility, design and conduct of a pragmatic randomised clinical trial comparing new techniques of implant-based breast reconstruction. Pilot Feasibility Stud 2016; 2:41. [PMID: 27965859 PMCID: PMC5154059 DOI: 10.1186/s40814-016-0085-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 06/10/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Implant-based breast reconstruction (IBBR) is the most commonly performed reconstructive procedure in the UK. The introduction of techniques to augment the subpectoral pocket has revolutionised the procedure, but there is a lack of high-quality outcome data to describe the safety or effectiveness of these techniques. Randomised controlled trials (RCTs) are the best way of comparing treatments, but surgical RCTs are challenging. The iBRA (implant breast reconstruction evaluation) study aims to determine the feasibility, design and conduct of a pragmatic RCT to examine the effectiveness of approaches to IBBR. METHODS/DESIGN The iBRA study is a trainee-led research collaborative project with four phases:Phase 1 - a national practice questionnaire (NPQ) to survey current practicePhase 2 - a multi-centre prospective cohort study of patients undergoing IBBR to evaluate the clinical and patient-reported outcomesPhase 3- an IBBR-RCT acceptability survey and qualitative work to explore patients' and surgeons' views of proposed trial designs and candidate outcomes.Phase 4 - phases 1 to 3 will inform the design and conduct of the future RCT All centres offering IBBR will be encouraged to participate by the breast and plastic surgical professional associations (Association of Breast Surgery and British Association of Plastic Reconstructive and Aesthetic Surgeons). Data collected will inform the feasibility of undertaking an RCT by defining current practice and exploring issues surrounding recruitment, selection of comparator arms, choice of primary outcome, sample size, selection criteria, trial conduct, methods of data collection and feasibility of using the trainee collaborative model to recruit patients and collect data. DISCUSSION The preliminary work undertaken within the iBRA study will determine the feasibility, design and conduct of a definitive RCT in IBBR. It will work with the trainee collaborative to build capacity by creating an infrastructure of research-active breast and plastic surgeons which will facilitate future high-quality research that will ultimately improve outcomes for all women seeking reconstructive surgery. TRIAL REGISTRATION ISRCTN37664281.
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Affiliation(s)
- Shelley Potter
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Room 3.12 Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Elizabeth J. Conroy
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, Clinical Trials Research Centre, University of Liverpool, Liverpool, L69 3GS UK
| | - Paula R. Williamson
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, Clinical Trials Research Centre, University of Liverpool, Liverpool, L69 3GS UK
| | - Steven Thrush
- Breast Unit, Worcester Royal Hospital. Charles Hastings Way, Worcester, WR5 1DD UK
| | - Lisa J. Whisker
- Breast Institute, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham, NG5 1PB UK
| | - Joanna M Skillman
- Department of Plastic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX UK
| | - Nicola L. P. Barnes
- The Nightingale Centre Breast Unit, University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT UK
| | - Ramsey I. Cutress
- Breast Unit, University Hospital Southampton, Tremona Road, Southampton, Hampshire SO16 6YD UK
- Faculty of Medicine, University of Southampton, University Road, Southampton, SO17 1BJ UK
| | - Elizabeth M. Teasdale
- Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital, Prescot Street, Liverpool, L7 8XP UK
| | - Nicola Mills
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Room 3.12 Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Senthurun Mylvaganam
- New Cross Hospital, Royal Wolverhampton Hospitals NHS Trust, Wednesfield Way, Wolverhampton, WV10 0QP UK
| | - Olivier A. Branford
- Department of Plastic Surgery, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ UK
| | | | - Abhilash Jain
- Imperial College London NHS Trust, London, SW7 2AZ UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7HE UK
| | - Matthew D. Gardiner
- Imperial College London NHS Trust, London, SW7 2AZ UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7HE UK
| | - Jane M. Blazeby
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Room 3.12 Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Christopher Holcombe
- Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital, Prescot Street, Liverpool, L7 8XP UK
| | - on behalf of the Breast Reconstruction Research Collaborative
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Room 3.12 Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, Clinical Trials Research Centre, University of Liverpool, Liverpool, L69 3GS UK
- Breast Unit, Worcester Royal Hospital. Charles Hastings Way, Worcester, WR5 1DD UK
- Breast Institute, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham, NG5 1PB UK
- Department of Plastic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX UK
- The Nightingale Centre Breast Unit, University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT UK
- Breast Unit, University Hospital Southampton, Tremona Road, Southampton, Hampshire SO16 6YD UK
- Faculty of Medicine, University of Southampton, University Road, Southampton, SO17 1BJ UK
- Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital, Prescot Street, Liverpool, L7 8XP UK
- New Cross Hospital, Royal Wolverhampton Hospitals NHS Trust, Wednesfield Way, Wolverhampton, WV10 0QP UK
- Department of Plastic Surgery, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ UK
- City Hospital, Dudley Road, West Midlands, B18 7QH UK
- Imperial College London NHS Trust, London, SW7 2AZ UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7HE UK
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Apte A, Walsh M, Chandrasekharan S, Chakravorty A. Single-stage immediate breast reconstruction with acellular dermal matrix: Experience gained and lessons learnt from patient reported outcome measures. Eur J Surg Oncol 2015; 42:39-44. [PMID: 26651226 DOI: 10.1016/j.ejso.2015.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 09/27/2015] [Accepted: 10/19/2015] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Acellular Dermal Matrix (ADM) assisted breast reconstruction has transformed the single-stage Immediate Breast Reconstruction (IBR) with an impact on the cosmetic outcomes. However, there is limited data available on patient reported outcomes. This study highlights the Patient Reported Outcome Measures (PROMs), post-operative complications and lessons learnt from ADM assisted single-stage immediate breast reconstruction. METHODS This prospective study enrolled consecutive patients from Feb 2012 - May 2015 undergoing mastectomy with direct-to-implant ADM assisted breast reconstruction, using Strattice™ (Acelity, San Antonio, TX, USA). Patients were recruited from the beginning of our unit's use of ADMs and completed a post-operative questionnaire at 6 weeks, covering pre-operative, operative and post-operative outcomes. Information on tumour biology and post-operative complications was obtained from the medical notes. RESULTS This study included 49 patients undergoing a total of 53 procedures. Following surgery 93.3% of women reported a high level of body confidence when clothed. 6.7% of patients reported severe post-operative pain during the first week. Mean length of hospital stay was 1.7 days, return to light activities was within 2.5 weeks and normal activities in 5.4 weeks. Implant loss at 3 months occurred in 5.7% of procedures, of which two thirds were smokers. CONCLUSIONS PROMs for Strattice™ ADM based reconstruction show high levels of satisfaction with cosmetic outcomes, low incidences of severe post-operative pain and a short recovery process. PROMs help us to better describe patients' experience, allowing women to make more informed choices about ADM based breast reconstruction, which reassures and helps to achieve better outcomes.
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Affiliation(s)
- A Apte
- Colchester Hospital University NHS Foundation Trust, Colchester General Hospital, Turner Rd, Essex, CO4 5JL, UK.
| | - M Walsh
- Colchester Hospital University NHS Foundation Trust, Colchester General Hospital, Turner Rd, Essex, CO4 5JL, UK.
| | - S Chandrasekharan
- Colchester Hospital University NHS Foundation Trust, Colchester General Hospital, Turner Rd, Essex, CO4 5JL, UK.
| | - A Chakravorty
- Colchester Hospital University NHS Foundation Trust, Colchester General Hospital, Turner Rd, Essex, CO4 5JL, UK.
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Single-stage breast reconstruction using Strattice™: A retrospective study. J Plast Reconstr Aesthet Surg 2015; 69:227-33. [PMID: 26723835 DOI: 10.1016/j.bjps.2015.11.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 11/09/2015] [Accepted: 11/14/2015] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Strattice™, a porcine acellular dermal matrix, has emerged as a product to augment implant-based breast reconstruction. It aims to resolve problems related to poor tissue coverage of the implant. Presently, evidence justifying the use of Strattice in breast reconstruction is lacking. The objective of this study is to assess the clinical outcomes of a patient cohort that underwent single-stage implant-based breast reconstruction with the additional use of Strattice. METHODS We conducted a retrospective chart review of patients who underwent single-stage breast reconstruction with the use of Strattice. All cases of breast reconstruction after oncologic or prophylactic mastectomy between 2010 and 2014 in one of eight different centres in the Netherlands were included. Patient demographics, treatment characteristics and clinical outcome data were collected. The outcomes were presented using descriptive statistics, and the associations were evaluated using Fisher's exact test. RESULTS Eighty-eight patients who underwent either unilateral (60 patients) or bilateral (25 patients) (n = 110 breasts) single-stage breast reconstruction with the use of Strattice were identified. The indication for mastectomy was therapeutic in 69.1% (76) of cases and prophylactic in 30.9% (34) of cases. The reported minor complications included seroma (20.9%), skin necrosis (20.0%), wound dehiscence (11.8%), erythema/inflammation (14.5%) and infection (11.8%). In 22 breasts (22.7%), reoperation was necessary, with explantation of the implant in 11 breasts (11.8%). CONCLUSIONS In this cohort, the total complication rate was very high (78%). Although most complications were minor, reoperation was performed in 22.7%, with explantation of the implant in 11.8% of breasts. We suggest that patient selection, experience of the surgeon and handling of early complications are factors playing a crucial role in the success of the operation. The use of a Strattice sheet in single-stage implant-based breast reconstruction may be a promising technique, but more evidence from prospective, randomized studies is necessary to justify its use. LEVEL OF EVIDENCE IV.
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Lee KT, Mun GH. Prosthetic breast reconstruction in previously irradiated breasts: A meta-analysis. J Surg Oncol 2015; 112:468-75. [DOI: 10.1002/jso.24032] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 08/19/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Kyeong-Tae Lee
- Department of Plastic Surgery; Samsung Medical Center; Sungkyunkwan University School of Medicine; Gangnam-gu Seoul South Korea
| | - Goo-Hyun Mun
- Department of Plastic Surgery; Samsung Medical Center; Sungkyunkwan University School of Medicine; Gangnam-gu Seoul South Korea
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Ng CE, Pieri A, Fasih T. Porcine acellular dermis-based breast reconstruction: complications and outcomes following adjuvant radiotherapy. EUROPEAN JOURNAL OF PLASTIC SURGERY 2015; 38:459-462. [PMID: 26635446 PMCID: PMC4656711 DOI: 10.1007/s00238-015-1130-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 07/01/2015] [Indexed: 11/23/2022]
Abstract
Background Acellular dermal matrices (ADM) such as StratticeTM are increasingly used in UK during implant-based reconstruction. However, there are mixed opinions regarding the compatibility of radiotherapy treatment in pre- and post-reconstructed breasts. The aims of this study are to audit the rates of radiation induced complications in patients who underwent breast reconstruction using StratticeTM and establish whether there is an association between timing of radiotherapy and complication rates. Methods Retrospective data collection was performed for all patients who underwent skin-sparing mastectomy and immediate or delayed StratticeTM-based reconstruction, and received pre- or post-reconstruction radiotherapy from July 2010 to November 2014. Results The age ranged from 33 to 78 years (mean age 51 ± 10.6) with a mean follow-up time of 21 months. There were 25 StratticeTM-based reconstructions performed. Sixteen had delayed reconstruction, and 9 had skin-sparing mastectomy and immediate reconstruction. There were 4 (16 %) abandoned procedures due to inability to stretch the mastectomy flap secondary to poor skin compliance. Two women (8 %) presented 4 and 9 months later with wound breakdown. One case (4 %) developed severe capsular contracture following radiotherapy post-reconstruction and 1 case (4 %) of implant rupture. There were no episodes of extrusion or implant infection. Overall complication rates were 32 %. The majority (75 %) of complications occurred in breasts reconstructed post-radiotherapy; however, this is not significant when analysed using chi-square (p = 0.43). Conclusions Our evidence suggests that there is no difference in complication rates in pre- and post-radiation individuals; this would suggest that implant-based reconstruction using StratticeTM should not be an absolute contraindication in pre- or post-radiotherapy patients. However, when planning these procedures, it is paramount that the increased risks are emphasised to patients in order to better manage patient expectation in cases where complications arise. Level of Evidence: Level III, risk / prognostic study.
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Affiliation(s)
- Cho Ee Ng
- Surgical Department, Queen Elizabeth Hospital, Gateshead, NE9 6SX UK
| | - Andrew Pieri
- Surgical Department, Queen Elizabeth Hospital, Gateshead, NE9 6SX UK
| | - Tarannum Fasih
- Surgical Department, Queen Elizabeth Hospital, Gateshead, NE9 6SX UK
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