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Chu JJ, Nelson JA, Kokosis G, Haglich K, McKernan CD, Rubenstein R, Vingan PS, Allen RJ, Coriddi MR, Dayan JH, Disa JJ, Mehrara BJ, Matros E. A Cohort Analysis of Early Outcomes After AlloDerm, FlexHD, and SurgiMend Use in Two-Stage Prepectoral Breast Reconstruction. Aesthet Surg J 2023; 43:1491-1498. [PMID: 37551639 PMCID: PMC11184452 DOI: 10.1093/asj/sjad246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/26/2023] [Accepted: 08/05/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Acellular dermal matrix (ADM) is frequently utilized in prepectoral breast reconstruction, but few studies have examined the role of ADM type in complication risk. OBJECTIVES This study was performed to determine the impact of ADM type on early complication rates in 2-stage alloplastic prepectoral breast reconstruction. METHODS We performed a cohort examination of all patients who underwent mastectomy with immediate 2-stage alloplastic prepectoral breast reconstruction with ADM support at Memorial Sloan Kettering Cancer Center from 2018 to 2021. ADM types utilized included AlloDerm (LifeCell Corporation, Branchburg, NJ), FlexHD (MTF Biologics, Edison, NJ), and SurgiMend (Integra LifeSciences Corporation, Princeton, NJ). Complication rates based on the number of tissue expanders (TEs) were determined for each ADM type. Performance of multivariate logistic regression determined the impact of ADM type on complication risk after accounting for confounders. RESULTS Overall, 726 patients (1054 TEs: 194 AlloDerm, 93 FlexHD, 767 SurgiMend) were included. The 3 cohorts differed in terms of mastectomy type (nipple-sparing: 23.5% of AlloDerm, 33.3% of FlexHD, 19.1% of SurgiMend, P = .038); ADM perforation (perforated: 94.8% of AlloDerm, 98.2% of FlexHD, 100% of SurgiMend, P < .001); and ADM size (AlloDerm: 153.2 cm2 [37.6], SurgiMend: 198.7 cm2 [10.4], FlexHD: 223.7 cm2 [37.9], P < .001). On univariate examination, no differences existed between ADM types for seroma, infection, exposure, malposition, or TE loss. Additionally, after adjustment for confounders with multivariate regression, no ADM type had higher odds of TE loss. CONCLUSIONS In this large cohort of prepectoral reconstruction patients, ADM type did not significantly affect the risk of complications. Additional prospective studies are warranted to better evaluate ADM choice for prepectoral breast reconstruction. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | - Jonas A Nelson
- Corresponding Author: Dr Jonas A. Nelson, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, 321 E 61st St., New York, NY 10065, USA. E-mail:
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Makarewicz N, Perrault D, Sharma A, Shaheen M, Kim J, Calderon C, Sweeney B, Nazerali R. Comparing the Outcomes and Complication Rates of Biologic vs Synthetic Meshes in Implant-Based Breast Reconstruction: A Systematic Review. Ann Plast Surg 2023; 90:516-527. [PMID: 37146317 DOI: 10.1097/sap.0000000000003512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
OBJECTIVE This systematic review evaluates all published studies comparing biologic and synthetic meshes in implant-based breast reconstruction (IBBR), to determine which category of mesh produces the most favorable outcomes. SUMMARY BACKGROUND DATA Breast cancer is the most common cancer in women globally. Implant-based breast reconstruction is currently the most popular method of postmastectomy reconstruction, and recently, the use of surgical mesh in IBBR has become commonplace. Although there is a long-standing belief among surgeons that biologic mesh is superior to synthetic mesh in terms of surgical complications and patient outcomes, few studies exist to support this claim. METHODS A systematic search of the EMBASE, PubMed, and Cochrane databases was performed in January 2022. Primary literature studies comparing biologic and synthetic meshes within the same experimental framework were included. Study quality and bias were assessed using the validated Methodological Index for Non-Randomized Studies criteria. RESULTS After duplicate removal, 109 publications were reviewed, with 12 meeting the predetermined inclusion criteria. Outcomes included common surgical complications, histological analysis, interactions with oncologic therapies, quality of life measures, and esthetic outcomes. Across all 12 studies, synthetic meshes were rated as at least equivalent to biologic meshes for every reported outcome. On average, the studies in this review tended to have moderate Methodological Index for Non-Randomized Studies scores. CONCLUSION This systematic review offers the first comprehensive evaluation of all publications comparing biologic and synthetic meshes in IBBR. The consistent finding that synthetic meshes are at least equivalent to biologic meshes across a range of clinical outcomes offers a compelling argument in favor of prioritizing the use of synthetic meshes in IBBR.
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Affiliation(s)
- Nathan Makarewicz
- From the Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA
| | - David Perrault
- From the Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA
| | - Ayushi Sharma
- From the Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA
| | - Mohammed Shaheen
- From the Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA
| | - Jessica Kim
- Loma Linda School of Medicine, Loma Linda, CA
| | - Christian Calderon
- From the Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA
| | - Brian Sweeney
- From the Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA
| | - Rahim Nazerali
- From the Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA
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Hillberg N, Hogenboom J, Hommes J, Van Kuijk S, Keuter X, van der Hulst R. Risk of major postoperative complications in breast reconstructive surgery with and without an acellular dermal matrix; Development of a prognostic prediction model. JPRAS Open 2022; 33:92-105. [PMID: 35812357 PMCID: PMC9260237 DOI: 10.1016/j.jpra.2022.04.007] [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: 12/19/2021] [Accepted: 04/21/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Acellular dermal matrices (ADM) have been suggested to allow for different approaches and reduce the risk of postoperative complications in implant-based breast surgery. Surgeons seem to embrace ADMs around the world, although a lack of consistent evidence regarding the factors that increase the risk of major postoperative complications remains. Purpose To develop and internally validate a model to predict the risk of a major postoperative complication in breast reconstructive surgery with and without an ADM. Methodology The DBIR is an opt-out registry that holds characteristics of all breast implant surgeries in the Netherlands since 2015. Using a literature-driven preselection of predictors, multivariable mixed-effects logistic regression modelling was used to develop the prediction model. Results A total of 2939 breasts were eligible, of which 11% underwent an ADM-assisted procedure (single-stage or two-stage). However, 31% underwent a two-stage procedure (with or without the use of ADM). Of all breasts, 10.2% developed a major postoperative complication. Age (OR 1.01), delayed timing (OR 0.71), and two-stage technique (OR 4.46) were associated with the outcome. Conclusion The data suggest that ADM use was not associated with a major postoperative complication, while two-stage reconstructions were strongly associated with an increased risk of major complications. Despite these findings, ADMs are not as popular in the Netherlands as in the USA. The predictive capabilities of the developed model are mediocre to poor, but because of the above findings, we believe that the role of the two-stage technique as a golden standard should be put up for debate.
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Affiliation(s)
- N.S. Hillberg
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Postal box 5800, 6202 Maastricht, The Netherlands
- School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Postal box 616, 6200 MD Maastricht, The Netherlands
- Author responsible for editorial correspondence: N.S. Hillberg, Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Postal box 5800, 6202 Maastricht, The Netherlands. +31 433877000.
| | - J. Hogenboom
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - J. Hommes
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Postal box 5800, 6202 Maastricht, The Netherlands
| | - S.M.J. Van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - X.H.A. Keuter
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Postal box 5800, 6202 Maastricht, The Netherlands
| | - R.R.W.J. van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Postal box 5800, 6202 Maastricht, The Netherlands
- School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Postal box 616, 6200 MD Maastricht, The Netherlands
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Saldanha IJ, Broyles JM, Adam GP, Cao W, Bhuma MR, Mehta S, Pusic AL, Dominici LS, Balk EM. Implant-based Breast Reconstruction after Mastectomy for Breast Cancer: A Systematic Review and Meta-analysis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4179. [PMID: 35317462 PMCID: PMC8932484 DOI: 10.1097/gox.0000000000004179] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/13/2022] [Indexed: 12/26/2022]
Abstract
Women undergoing implant-based reconstruction (IBR) after mastectomy for breast cancer have numerous options, including timing of IBR relative to radiation and chemotherapy, implant materials, anatomic planes, and use of human acellular dermal matrices. We conducted a systematic review to evaluate these options. Methods We searched Medline, Embase, Cochrane CENTRAL, CINAHL, and ClinicalTrials.gov for studies, from inception to March 23, 2021, without language restriction. We assessed risk of bias and strength of evidence (SoE) using standard methods. Results We screened 15,936 citations. Thirty-six mostly high or moderate risk of bias studies (48,419 patients) met criteria. Timing of IBR before or after radiation may result in comparable physical, psychosocial, and sexual well-being, and satisfaction with breasts (all low SoE), and probably comparable risks of implant failure/loss or explantation (moderate SoE). No studies addressed timing relative to chemotherapy. Silicone and saline implants may result in clinically comparable satisfaction with breasts (low SoE). Whether the implant is in the prepectoral or total submuscular plane may not impact risk of infections (low SoE). Acellular dermal matrix use probably increases the risk of implant failure/loss or need for explant surgery (moderate SoE) and may increase the risk of infections (low SoE). Risks of seroma and unplanned repeat surgeries for revision are probably comparable (moderate SoE), and risk of necrosis may be comparable with or without human acellular dermal matrices (low SoE). Conclusions Evidence regarding IBR options is mostly of low SoE. New high-quality research is needed, especially for timing, implant materials, and anatomic planes of implant placement.
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Affiliation(s)
- Ian J. Saldanha
- From the Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, R.I
- Department of Epidemiology, Brown University School of Public Health, Providence, R.I
| | - Justin M. Broyles
- Division of Plastic and Reconstructive Surgery, Department of Plastic Surgery, Harvard Medical School, Boston, Mass
| | - Gaelen P. Adam
- From the Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, R.I
| | - Wangnan Cao
- From the Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, R.I
| | - Monika Reddy Bhuma
- From the Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, R.I
| | - Shivani Mehta
- From the Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, R.I
| | - Andrea L. Pusic
- Division of Plastic and Reconstructive Surgery, Department of Plastic Surgery, Harvard Medical School, Boston, Mass
| | - Laura S. Dominici
- Division of Breast Surgery, Department of Surgery, Harvard Medical School, Boston, Mass
| | - Ethan M. Balk
- From the Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, R.I
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Acellular Dermal Matrix-Associated Contracture: A Clinical and Histologic Analysis of Patients Undergoing Prosthetic Breast Reconstruction. Plast Reconstr Surg 2021; 148:968-977. [PMID: 34495907 DOI: 10.1097/prs.0000000000008485] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Capsular contracture is a well-recognized complication following prosthetic breast reconstruction. It has been the authors' observation that some patients undergoing breast reconstruction experience contracture specifically of the acellular dermal matrix placed at the time of their tissue expander insertion. The goal of the authors' study was to identify clinical and histologic findings associated with the development of acellular dermal matrix-associated contracture. METHODS The authors performed a retrospective cohort study of all patients undergoing bilateral implant-based breast reconstruction performed by the senior author (M.S.A.). Patients were excluded if they had radiation therapy to the breast. Patients with suspected acellular dermal matrix-associated contracture were identified by clinical photographs and review of operative notes. Histologic analysis was performed on specimens taken from two patients with acellular dermal matrix contracture. RESULTS The authors included a total of 46 patients (92 breasts), of which 19 breasts had suspected acellular dermal matrix-associated contracture. Acellular dermal matrix contracture was less common in direct-to-implant reconstruction (4.2 percent versus 26.5 percent; p = 0.020) and more common in breasts that had seromas (0 percent versus 15.8 percent; p = 0.001) or complications requiring early expander replacement. Contracted acellular dermal matrix had less vascularity and a lower collagen I-to-collagen III ratio, and was twice as thick as noncontracted acellular dermal matrix. CONCLUSIONS The authors have described a distinct phenomenon of acellular dermal matrix-associated contracture that occurs in a small subset of breasts where acellular dermal matrix is used. This merits further investigation. Future work will be required to better characterize the clinical factors that make acellular dermal matrix-associated contracture more likely to occur. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Comparison of 30-day Clinical Outcomes with SimpliDerm and AlloDerm RTU in Immediate Breast Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3648. [PMID: 34150429 PMCID: PMC8208427 DOI: 10.1097/gox.0000000000003648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/27/2021] [Indexed: 12/04/2022]
Abstract
Background: Acellular dermal matrix (ADM) is widely used in breast reconstruction, and outcomes of these procedures may be improved through optimized product design. SimpliDerm is a new human ADM designed to closely preserve the architecture of native dermis, with the goal of improving surgical outcomes. This study reports the initial (30-day) clinical experience with SimpliDerm compared with AlloDerm Ready-To-Use (RTU) in ADM-assisted breast reconstruction. Methods: Clinical characteristics and outcomes of 59 consecutive patients who underwent immediate 2-stage reconstruction with SimpliDerm (n = 28) or AlloDerm RTU (n = 31) following mastectomy are reported. Results: Fifty-nine women (108 breasts) underwent posmastectomy breast reconstruction with SimpliDerm or AlloDerm RTU. Mean patient age was 51.1 years, and mean body mass index was 28.2 kg/m2. Reconstructions were predominantly prepectoral (95.4%), used tissue expanders (100%), and followed a skin-sparing (64%) approach to mastectomy. Mean time to final drain removal did not differ between groups (17.0 days, SimpliDerm versus 17.7 days, AlloDerm RTU). Adverse events occurred in 13 (22%) patients; none considered serious—all were mild or moderate in intensity. Adverse event rates did not differ between groups. The observed adverse event profiles and rates are similar to those published for other ADMs in immediate breast reconstruction. Conclusions: There remains a clinical need for ADMs with more optimal characteristics. This case series describes comparable outcomes with SimpliDerm and AlloDerm RTU over 30 days after immediate 2-stage breast reconstruction.
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Berna G, Cagli B, Persichetti P, Cogliandro A, Silan F, Maritan M, Dell'Antonia F. Feasibility study on equine acellular pericardium matrix (APM): A new tool for breast reconstruction. J Plast Reconstr Aesthet Surg 2020; 73:2150-2155. [PMID: 32513644 DOI: 10.1016/j.bjps.2020.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 03/06/2020] [Accepted: 05/09/2020] [Indexed: 11/19/2022]
Abstract
The advent of acellular dermal matrix (ADM) for lower pole coverage allows immediate reconstructions with improved aesthetic outcomes and faster recovery. This study describes for the first time, the use of a new acellular pericardium matrix (APM) in implant-based breast reconstruction and characterises its safety profile. Equity is a membrane with a natural cross-linked structure with many of the properties of ADMs, but improved resistance and reduced thickness. A retrospective data collection of all Equity APM reconstructions was conducted at two Italian hospital centres with substantial experience using biomaterials. Between May 2013 and October 2018, a total of 63 APM-assisted breast reconstructions were performed in 55 women. The reconstructed breasts were small to medium and the mean implant weight was 285 g, ranging from 145 g to 685 g. Two patients were previously irradiated while seven received post-operative radiation; five were active smokers and six were hypertensive. Complications included visibility in the upper pole (9.5%), seroma (1.6%), dehiscence, infection and necrosis (3.2% for each). Implant loss occurred in 3.2% of the cases. The patients were highly satisfied, reporting scores above 50 for each section of the Breast-Q questionnaire. With an acceptable complication rate, the use of the equine APM can be considered safe with satisfactory aesthetic results. Although the retrospective nature of this study limits its clinical impact, the use of Equity can be considered a viable alternative to thicker and expensive ADMs.
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Affiliation(s)
- Giorgio Berna
- Ca' Foncello Hospital, ULSS2 Marca Trevigiana, via S. Ambrogio di Fiera, n. 37, 31100, Treviso, Italy.
| | - Barbara Cagli
- Policlinico Universitario Campus Bio-Medico, via Alvaro del Portillo 200, 00128, Roma, Italy
| | - Paolo Persichetti
- Policlinico Universitario Campus Bio-Medico, via Alvaro del Portillo 200, 00128, Roma, Italy
| | - Annalisa Cogliandro
- Policlinico Universitario Campus Bio-Medico, via Alvaro del Portillo 200, 00128, Roma, Italy
| | - Francesco Silan
- Ca' Foncello Hospital, ULSS2 Marca Trevigiana, via S. Ambrogio di Fiera, n. 37, 31100, Treviso, Italy
| | - Monia Maritan
- Ca' Foncello Hospital, ULSS2 Marca Trevigiana, via S. Ambrogio di Fiera, n. 37, 31100, Treviso, Italy
| | - Francesco Dell'Antonia
- Ca' Foncello Hospital, ULSS2 Marca Trevigiana, via S. Ambrogio di Fiera, n. 37, 31100, Treviso, Italy
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Surgical Outcomes in Prepectoral Breast Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2744. [PMID: 32440414 PMCID: PMC7209837 DOI: 10.1097/gox.0000000000002744] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 02/05/2020] [Indexed: 11/26/2022]
Abstract
Background: Prepectoral breast reconstruction has reemerged as a popular option for prosthetic-based breast reconstruction. Recent published literature highlights good outcomes; however, techniques are evolving and options exist for different technologies. The aim of this study is to evaluate short-term complication rates of prepectoral reconstructions using Cortiva acellular dermal matrix. Methods: A multicenter retrospective study was conducted of all patients who underwent mastectomy with immediate direct-to-implant or 2-stage prepectoral breast reconstruction with Cortiva (RTI Surgical, Alachua, Fla.) between January 2016 and September 2018. The incidence of surgical complications was determined and studied against patient demographics and procedural details. Results: One-hundred eighteen patients met the inclusion criteria for a total of 183 individual breasts reconstructed with prepectoral implant. Average length of follow-up was 9.26 months (range, 1.0 month to 2.5 years). Thirty-two breasts (17.49%) experienced 1 or more complications. Prepectoral reconstruction was successful 89.07% of the time. Infection was the most common cause of both reoperation and implant failure, with 7.65% of all breasts requiring washout and 5.46% failing prosthetic reconstruction secondary to infection. Conclusions: Surgical outcomes for prepectoral breast reconstruction using 2-stage and direct-to-implant are similar and comparable to the literature for dual-plane reconstruction, with infection being the main cause of failure.
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Park BY, Hong SE, Hong MK, Woo KJ. The influence of contralateral breast augmentation on the development of complications in direct-to-implant breast reconstruction. J Plast Reconstr Aesthet Surg 2020; 73:1268-1276. [PMID: 32359856 DOI: 10.1016/j.bjps.2019.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 10/06/2019] [Accepted: 12/30/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Simultaneous contralateral augmentation in direct-to-implant (DTI) breast reconstruction may increase the risk of skin flap necrosis on the reconstruction side due to increased tension on the skin flap when implants are larger than the original breast size. The purpose of this study was to evaluate whether the contralateral augmentation procedure affects complications in unilateral DTI breast reconstruction. METHODS Patients who underwent immediate unilateral DTI breast reconstruction from January 2013 to July 2017 were included in this study. Data were collected through retrospective review of individual medical records. The primary outcome variable was the development of perioperative complications including skin flap necrosis. Univariable and multivariable logistic regression analyses were performed to identify risk factors for complications. RESULTS A total of 121 patients who underwent unilateral immediate DTI breast reconstruction were included in this study. Twenty-one patients (17.4%) underwent simultaneous contralateral augmentation mammoplasty and 100 patients (82.6%) underwent DTI without contralateral augmentation. Overall complications were not different between the contralateral augmentation and no-augmentation groups (23.8% vs. 31%, respectively, p = 0.512). The frequency of skin flap necrosis in the augmentation group (14.3%) was not significantly different from that in the no-augmentation group (18.0%, p > 0.999). In multivariable analysis, mastectomy weight was the only predictor for complications (p = 0.053) and contralateral augmentation was not associated with development of complications. CONCLUSION Contralateral breast augmentation in DTI breast reconstruction is not a risk factor for complications and can be safely performed in selected patients.
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Affiliation(s)
- Bo Young Park
- Department of Plastic Surgery, College of Medicine, Ewha Womans University, 1071 Anyangchen-ro, Yangchen-ku, Seoul, South Korea
| | - Seung Eun Hong
- Department of Plastic Surgery, College of Medicine, Ewha Womans University, 1071 Anyangchen-ro, Yangchen-ku, Seoul, South Korea
| | - Min Ki Hong
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, 36 Digital-ro, Gwangmyeong 14241, Korea
| | - Kyong-Je Woo
- Department of Plastic Surgery, College of Medicine, Ewha Womans University, 1071 Anyangchen-ro, Yangchen-ku, Seoul, South Korea.
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Acellular Dermal Matrix Performance Compared with Latissimus Dorsi Myocutaneous Flap in Expander-Based Breast Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 7:e2414. [PMID: 31942389 PMCID: PMC6908382 DOI: 10.1097/gox.0000000000002414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 05/29/2019] [Indexed: 11/25/2022]
Abstract
Latissimus dorsi myocutaneous flap (LDMF) with tissue expander provides excellent results in breast reconstruction. Acellular dermal matrix (ADM) has been used in expander-based reconstruction (EBR) with good results. This study assesses how ADM compares to LDMF in EBR. Methods The cohorts comprised 124 patients (218 breasts) who had EBR using ADM between 2006 and 2012, and 242 patients (266 breasts) who had EBR using LDMF between 1994 and 2012. Postoperative complications, reoperations, Breast-Q scores, and objectively assessed aesthetic outcomes were compared. Results Median age was 55 years for both ADM (range 23-84) and LDMF (range 26-88) groups. No statistically significant differences were noted between the groups in the rates of major postoperative complications (P > 0.3). Forty-nine of the 218 (22.5%) in the ADM group and 67 of 266 (25.2%) in the LDMF group had a total of 63 and 84 reoperations, respectively (P = 0.52), with no significant differences in the reoperations rate (P > 0.3). No significant differences were observed in the Breast-Q scores. Some categorical differences were noted in the aesthetic outcomes; however, the difference between the overall outcomes was not significant (P = 0.54). Conclusion Our study revealed no statistically significant differences in the complications or reoperation rates, patient satisfaction, or overall aesthetic outcomes when comparing the use of ADM to LDMF in EBR. In conclusion, this study supports the hypothesis that ADM performs as well as LDMF in EBR.
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Results of XPAND II: A Multicenter, Prospective, Continued-Access Clinical Trial Using the AeroForm Tissue Expander for Two-Stage Breast Reconstruction. Plast Reconstr Surg 2019; 145:21e-29e. [PMID: 31881599 DOI: 10.1097/prs.0000000000006395] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND XPAND II was a prospective, multicenter, single-arm, open-label, continued-access study designed to confirm the results from the XPAND study, a multicenter, prospective, randomized study for breast reconstruction. The AeroForm device received clearance from the U.S. Food and Drug Administration in December 2016 based on the results of the pivotal XPAND trial, which compared the AeroForm to saline expanders. METHODS Fifty women were treated in the XPAND II study and implanted with the AeroForm device (86 devices). The study endpoint was successful completion of the second-stage surgery, and secondary endpoints were days to complete expansion and reconstruction, and patient/physician satisfaction. Following implantation, women were administered 10-cc doses of carbon dioxide at home up to three times daily. When adequate expansion was achieved, the expanders were exchanged for standard breast implants. RESULTS The primary endpoint (successful exchange to standard breast implant, precluding non-device-related failures) is 100 percent. All-cause interim success is 95 percent, with three subjects (four breasts) failing primary exchange because of non-device-related reasons. Median time to complete expansion was 21 days (range, 5 to 117 days). Median time to complete the reconstruction was 112 days (range, 55 to 329 days). Ninety-six percent of the subjects were very or moderately satisfied with the AeroForm expansion process. CONCLUSIONS Results of the XPAND II continued access study confirm and improve on previous results from the randomized trial (XPAND). These results validate that the AeroForm patient-controlled, needle-free carbon dioxide tissue expander is safe and effective for two-stage breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Negenborn VL, Dikmans REG, Bouman MB, Winters HAH, Twisk JWR, Ruhé PQ, Mureau MAM, Smit JM, Tuinder S, Hommes J, Eltahir Y, Posch NAS, van Steveninck-Barends JM, Meesters-Caberg MA, van der Hulst RRWJ, Ritt MJPF, Mullender MG. Predictors of complications after direct-to-implant breast reconstruction with an acellular dermal matrix from a multicentre randomized clinical trial. Br J Surg 2018; 105:1305-1312. [PMID: 29663320 PMCID: PMC6099293 DOI: 10.1002/bjs.10865] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/12/2017] [Accepted: 02/19/2018] [Indexed: 11/05/2022]
Abstract
BACKGROUND In the multicentre randomized trial BRIOS (Breast Reconstruction In One Stage), direct-to-implant (DTI) breast reconstruction with an acellular dermal matrix (ADM) was associated with a markedly higher postoperative complication rate compared with two-stage tissue expander/implant breast reconstruction. This study aimed to identify factors that contribute to the occurrence of complications after DTI ADM-assisted breast reconstruction. METHODS Data were obtained from the BRIOS study, including all patients treated with DTI ADM-assisted breast reconstruction. Logistic regression analyses were performed to identify factors predictive of postoperative complications. RESULTS Fifty-nine patients (91 breasts) were included, of whom 27 (35 breasts) developed a surgical complication. Reoperations were performed in 29 breasts (32 per cent), with prosthesis removal in 22 (24 per cent). In multivariable analyses, mastectomy weight was associated with complications (odds ratio (OR) 1·94, 95 per cent c.i. 1·33 to 2·83), reoperations (OR 1·70, 1·12 to 2·59) and removal of the implant (OR 1·55, 1·11 to 2·17). Younger patients (OR 1·07, 1·01 to 1·13) and those who received adjuvant chemotherapy (OR 4·83, 1·15 to 20·24) more frequently required reoperation. In univariable analyses, adjuvant radiotherapy showed a trend towards more complications (OR 7·23, 0·75 to 69·95) and removal of the implant (OR 5·12, 0·76 to 34·44), without reaching statistical significance. CONCLUSION Breast size appeared to be the most significant predictor of complications in DTI ADM-assisted breast reconstruction. The technique should preferably be performed in patients with small to moderate sized breasts. Registration number: NTR5446 ( http://www.trialregister.nl).
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Affiliation(s)
- V L Negenborn
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.,Amsterdam Public Health, Amsterdam, The Netherlands
| | - R E G Dikmans
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.,Amsterdam Public Health, Amsterdam, The Netherlands
| | - M B Bouman
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.,Amsterdam Public Health, Amsterdam, The Netherlands.,Department of Plastic Surgery, Alexander Monro Breast Cancer Hospital, Bilthoven, The Netherlands
| | - H A H Winters
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.,Amsterdam Public Health, Amsterdam, The Netherlands.,Department of Plastic Surgery, Alexander Monro Breast Cancer Hospital, Bilthoven, The Netherlands
| | - J W R Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands.,Amsterdam Public Health, Amsterdam, The Netherlands
| | - P Q Ruhé
- Department of Plastic, Reconstructive and Hand Surgery, Meander Medical Centre, Amersfoort, The Netherlands
| | - M A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - J M Smit
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.,Department of Plastic Surgery, Alexander Monro Breast Cancer Hospital, Bilthoven, The Netherlands
| | - S Tuinder
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J Hommes
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Y Eltahir
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - N A S Posch
- Department of Plastic, Reconstructive and Hand Surgery, Haga Ziekenhuis, The Hague, The Netherlands
| | | | - M A Meesters-Caberg
- Department of Plastic, Reconstructive and Hand Surgery, Orbis Medical Centre, Sittard, The Netherlands
| | - R R W J van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M J P F Ritt
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | - M G Mullender
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.,Amsterdam Public Health, Amsterdam, The Netherlands
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