Establishing an equipoise: Does the use of acellular dermal matrices in pre-pectoral implant-based breast reconstruction improve outcomes?

Abstract

IntroductionBreast cancer is the most common malignancy among females in the United Kingdom (UK). Surgical management commonly comprises mastectomy and reconstruction, of which implant-based breast reconstruction (IBBR) are most prevalent. Acellular dermal matrices (ADM) are widely used in pre-pectoral implant-based breast reconstruction, however there is limited high-quality evidence supporting their efficacy. This study aims to establish equipoise via an expert consensus survey. MethodsAn online survey was designed with a steering group of experts. Questions covered participant information, opinions regarding surgical outcomes with ADM use in pre-pectoral IBBR and opinions regarding available scientific evidence on the topic. The survey was advertised via national and international professional organisations. Quantitative and qualitative analyses were performed. ResultsThirty-two participants from the UK, Italy and Australia completed the survey. Key findings of this study include disagreement among participants regarding surgical outcomes associated with ADM use. Participants who believed that ADM reduced the risk of short-term complications and implant failure/explantation comprised a minority – 21.9%. Participants who felt that ADM use improved cosmetic outcomes and reduced long-term complications made up a relative majority – 43.8% and 40.6%, respectively. 56.3% of participants felt there was scarce scientific evidence on the topic. ConclusionsThis study provides an insight from international surgeons; establishing a lack of consensus on surgical outcomes, efficacy and evidence-base supporting the use of ADMs in pre-pectoral IBBR. Given this clinical equipoise, alongside the growing burden of breast-cancer associated morbidity and the need for reconstruction, the implications of this study are that large-scale, prospective, randomised-controlled data are needed to establish whether ADM use in pre-pectoral breast reconstruction improves outcomes.