Multicentre study of prepectoral breast reconstruction using acellular dermal matrix.

M Chandarana,S Harries

doi:10.1002/bjs5.50236

Abstract

BackgroundSingle‐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).MethodsAll 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.ResultsA 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.ConclusionPrepectoral 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.

Highlights

Women undergoing mastectomy for breast cancer or risk reduction should be offered an immediate breast reconstruction if deemed suitable[1]
The present study reports on surgical outcomes from a multicentre audit conducted in the UK on prepectoral direct-to-implant reconstruction using acellular dermal matrix (ADM), and factors affecting complication rates and implant loss
All centres across the UK performing prepectoral breast reconstructions using Braxon® ADM were invited to participate

Summary

Introduction

Women undergoing mastectomy for breast cancer or risk reduction should be offered an immediate breast reconstruction if deemed suitable[1]. 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. 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. Some 15⋅3 per cent of patients had a major complication, with a 90-day implant loss rate of 4⋅9 per cent. The duration of follow-up needs to be extended to examine outcomes in patients who received adjuvant radiotherapy

Methods

Results

Conclusion