Prepectoral Implant-based Reconstruction Research Articles

Abstract PO2-22-12: Patient-reported outcomes 3 and 18 months after prepectoral implant-based breast reconstruction: Results from the UK Pre-BRA multicentre prospective cohort study

Abstract Background: Prepectoral implant-based reconstruction (PPBR) with and without mesh is becoming the standard of care for prosthetic reconstruction in the UK. In addition to being easier and quicker to perform, the procedure is perceived to be associated with better patient-centred outcomes including decreased post-operative pain, avoidance of animation deformity and improved cosmesis. Evidence to support these benefits, however, is lacking. The UK PreBRA prospective multicentre cohort study (ISRCTN11898000) aimed to assess patient-reported outcomes (PROs) before and 3 and 18 months following PPBR to provide much needed evidence to support the effectiveness of the technique. Methods: Women aged 18 or over undergoing mastectomy for breast cancer or risk-reduction who opted to have PPBR between July 2019 and December 2020 were eligible to participate in the study. Demographic, operative, oncology and three-month complication data were collected. Participants were asked to complete the validated BREAST-Q questionnaire at before surgery and at 3 and 18 months following the procedure. Questionnaires were scored according to the developers’ instructions and scores compared over time. Exploratory analysis of covariance, adjusting for baseline scores was performed to explore factors impacting PROs following PPBR. Results: 347 women underwent PPBR at 40 centres across the UK. Of these, 334 (96.3%) completed PROMs at baseline with 237 (68.3%) completing at least two of the three main BREAST-Q scales at both 3 and 18 months. The median age of the cohort was 49 (range 23-74). Most women (n=291, 87.1%) had mastectomy for malignancy with a quarter (n=82, 24.6%) undergoing bilateral surgery. Approximately a fifth (n=68, 20.4%) had a body mass index >30 and 12% (n=40) were active smokers at the time of surgery. At 3 months, 68 (20.4%) had experienced a complication requiring readmission and/or re-operation and 27 (8.1%) experienced an implant loss. In the cohort overall, women undergoing PPBR reported slight increases in their ‘Satisfaction with Breasts’ scores from baseline to 3 months after surgery but by 18 months, their scores had fallen below baseline values (Table 1). ‘Physical well-being’ scores decreased from baseline to 3 months but then remained stable. No changes were seen in ‘Psychosocial well-being’ scores across the three timepoints. At 18 months, after adjusting for baseline BREAST Q scores, women having surgery for risk-reduction reported scores that were 10-16 points lower than those having surgery for malignancy across all four main domains for the BREAST-Q. This exceeded the minimum clinically meaningful difference and was highly statistically significant. Women with high mastectomy weights ( >600g) reported lower scores for ‘Physical’, ‘Psychosocial’ and ‘Sexual’ well-being but not ‘Satisfaction with Breasts’. Smoking adversely impacted ‘Psychosocial well-being’ and ‘Satisfaction with Breasts’ and women with BMI >30 reported lower ‘Physical well-being’ scores at 18 months. Having a major complication requiring readmission/re-operation did not affect BREAST-Q scores, but when considered separately, implant loss dramatically impacted all BREAST-Q domains Conclusions: Women having PPBR report short-term improvements in ‘Satisfaction with Breasts’ scores but these are not maintained over time and decrease to below baseline 18 months after surgery. ‘Physical well-being’ also decreased after PPBR despite no disruption to the pectoralis muscle. Women having surgery for risk-reduction reported the worse PROs. Further work is needed to establish the long-term patient-reported outcomes of PPBR and factors impacting these. Citation Format: Leigh Johnson, Kate Harvey, Parisa Sinai, Nicola Mills, Paul White, Chris Holcombe, Shelley Potter. Patient-reported outcomes 3 and 18 months after prepectoral implant-based breast reconstruction: Results from the UK Pre-BRA multicentre prospective cohort study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-22-12.

Association of Neoadjuvant Chemotherapy With Postoperative Outcomes in Immediate Prepectoral Prosthetic Breast Reconstruction.

Neoadjuvant chemotherapy (NACT) followed by total mastectomy and immediate reconstruction has become an important strategy in the treatment of breast cancer. Although the safety of subpectoral implant-based breast reconstruction with NACT has been extensively evaluated, the safety in prepectoral reconstruction has not been clearly elucidated. We aimed to evaluate the association of NACT with immediate prepectoral breast reconstruction outcomes. A retrospective review of patients who underwent total mastectomy and immediate implant-based prepectoral breast reconstruction between May and December 2021 was conducted. Patients were categorized into 2 groups: those receiving NACT and those not receiving it. Postoperative complication rates were compared between the 2 groups. The independent association between NACT and the complication profiles was evaluated. Propensity score matching was also conducted. We analyzed 343 cases, including 85 who received NACT treatment and 258 who did not. Compared with the non-NACT group, the NACT group was younger, had a higher body mass index, and a higher rate of adjuvant radiotherapy. There were no differences in the rates of overall complications or type of complication between the 2 groups. In the multivariable logistic analyses, NACT did not show a significant association with the development of adverse outcomes. Similar results were observed in propensity score matching analyses. Our results suggest that receiving NACT may not have a significant detrimental effect on the postoperative outcomes of immediate prepectoral prosthetic reconstructions. Conducting prepectoral implant-based reconstruction in the setting of NACT might be safe and provide acceptable outcomes.

The Impact of Breast Implant Cohesivity on Rippling and Revision Procedures in 2-Stage Prepectoral Breast Reconstruction

Abstract Background Rippling remains one of the most common complications following prepectoral implant-based reconstruction (IBR). Objectives The purpose of this study was to assess how implant cohesivity, a measure of elasticity and form stability, affects the incidence of rippling in prepectoral IBR. Methods We performed a retrospective cohort study of 2-stage prepectoral IBR performed between January 2020 and June 2022 at the Brigham and Women's Hospital and Dana-Farber Cancer Institute, comparing outcomes in patients who received Allergan Natrelle least cohesive, moderately cohesive, and most cohesive silicone gel implants. Outcomes of interest were rippling and reoperation for fat grafting. Results A total of 129 patients were identified, of whom 52 had the least cohesive implants, 24 had the moderately cohesive implants, and 53 patients had the most cohesive implants. The mean follow-up time was 463 (±220) days. A decreased incidence of rippling was seen with moderately cohesive (odds ratio [OR] 0.30, P < .05) and most cohesive (OR 0.39, P < .05) implants. Third stage reoperation for fat grafting was less frequent in patients with the most cohesive implant (OR 0.07, P < .05). In subgroup analyses, the patients with the most cohesive implant, who did not receive fat grafting at the time of initial implant placement, did not require reoperation for fat grafting (0%). Conclusions The use of highly cohesive implants in prepectoral IBR is associated with decreased rippling and fewer reoperations for fat grafting. Level of Evidence: 3

Nipple necrosis rate with submuscular versus prepectoral implant-based reconstruction in nipple sparing mastectomy: Does it differ?

BackgroundThis study aims to compare the rate of nipple necrosis between the submuscular (SM) versus the prepectoral (PP) implant placement after immediate breast reconstruction (IBR). MethodsAn institutional review board-approved database was reviewed of patients who underwent nipple sparing mastectomy (NSM) with IBR at our institution between 2016 and 2019. Patients who had SM versus PP IBR were compared. Incidence of nipple necrosis was evaluated between the two groups. ResultsA total of 525 NSM with IBR were performed in 320 patients with SM reconstruction in 61% (n ​= ​322) and PP in 39% (n ​= ​203) of the mastectomies. Overall, 43 nipples experienced some form of necrosis with 1% of mastectomies experiencing nipple loss. There was no difference between SM group and PP group at the rate of nipple necrosis (9 ​% vs 7 %, P ​= ​0.71). ConclusionIn patients undergoing NSM with IBR, the rate of nipple necrosis, nipple loss or complications did not differ between groups whether the implant was placed SM or PP, supporting the safety of this newer procedure.

One-stage prepectoral reconstruction with “heavy” polypropylene mesh implant support in breast cancer surgery

Background. One-stage prepectoral implant-based reconstruction (OSPIBR) using biocompatible synthetic meshes support gained wide popularity in breast cancer surgery. Optimal structure of polypropylene mesh implants (PMI) and methods of its application are actively discussed.Aim. To study the effectiveness and safety of prosthesis support with “heavy” PMI in OSPIBR. Materials and methods. During 2019-2021 18 OSPIBR with "heavy" PMI support were performed after subcutaneous mastectomies in 14 patients. Cancer was indication for surgery in 13 cases (two of them - with BRCA1 mutation) and BRCA1 mutation solely - in 1 case. Foamed polyurethane covered silicone prosthesis (Polytech, Germany) was used for OSPIBR and "heavy" PMI PROLENE™ Polypropylene Mesh (Ethicon/Johnson & Johnson, USA) for prosthesis support by original method.Results. The overall complication rate was 5.6 % (1/18). It was a minor complication: limited aseptic skin necrosis along incision edge, successfully excised under local anesthesia. No cancer recurrences or capsular contracture formation were registrated during follow-up (6 months). The cosmetic outcome (Harvard score) was excellent in 11 of them and good in 3.Conclusions. "Heavy" PMI application by original technique in OSPIBR after subcutaneous mastectomy for breast cancer is a safe and effective method of prosthesis support.

ADMs and synthetic meshes improve implant-based breast reconstruction aesthetics, but at what cost?

Acellular dermal matrices (ADMs) have shown promise for use in reconstructive breast surgery as they improve aesthetic outcomes and decrease capsular contracture rates. However, concerns about their use remain because of the higher cost and complication profile. We report a single institution's implant-based-reconstruction (IBR) experience between 2007 and 2021, including cases performed by 51 plastic surgeons. For each stage of IBR, data on age, comorbidities, type of mesh used, and acute complications were collected. Of 1379 patients who underwent subpectoral IBR, 937 received an ADM or synthetic mesh as part of their reconstruction. 256 patients out of 264 treated with prepectoral IBR received an ADM or mesh. Infection and wound dehiscence rates were highest for patients who underwent prepectoral IBR with ADM. Both subpectoral and prepectoral IBR with ADM were associated with higher rates of infection and wound complications compared to without ADM or mesh, but only the difference among the subpectoral cohort reached statistical significance. Prepectoral IBR with ADM or mesh had the lowest rates of capsular contracture and aesthetic reoperations. Although the use of Vicryl® mesh in subpectoral IBR was associated with a higher risk of capsular contracture and skin flap necrosis compared to reconstruction with ADMs (10.53% versus 3.29%; p<0.05), Vicryl® was associated with fewer aesthetic revisions. Our study demonstrated that prepectoral IBR with ADM or mesh resulted in the fewest aesthetic reoperations and the lowest rates of capsular contracture. Infection and wound dehiscence rates were notably higher for patients who had reconstruction with ADM.

Опыт выполнения препекторальной реконструкции при раке молочной железы

Prepectoral implant-based simultaneous breast reconstruction is now employed more often and demonstrates good long-term outcomes with good quality of life after breast cancer (BC) surgery. We share our experience with reconstructive surgeries performed in 308 women diagnosed with BC by prepectoral implant placement. Polyurethane-coated implants were used in 50%, textured implants in 42.2%, and tissue expanders later replaced by textured implants in 7.8%. Prepectoral implant-based breast reconstruction was most commonly (74.5%) performed in women with early disease (stage 0-IIa). 150 women (48.7%) received chemotherapy after surgery. 40 women (12.9%) received radiotherapy (60% were women with polyurethane implants and 40% were women with textured implants). Radiotherapy was performed in 12 women (3.8%) with tissue expanders. In some women, complications occurred in the setting of ongoing radiotherapy and/or chemotherapy, which illustrates the need for careful patient selection for this surgical intervention. Improving surgical techniques and methods for preventing complications allows more active and effective introduction of prepectoral implant-based breast reconstruction. KEYWORDS: prepectoral reconstruction, implant-based breast reconstruction, breast cancer, tissue expander, textured implant, polyurethane implant. FOR CITATION: Khodorovich O.S., Solodkiy V.A., Kalinina-Masri A.A., Tashchyan A.A., Sherstneva T.V., Kleshneva V.O., Kanakhina L.B. Experience with prepectoral implant-based reconstruction for breast cancer. Russian Medical Inquiry. 2023;7(6):366–371 (in Russ.). DOI: 10.32364/2587-6821-2023-7-6-5.

Improving Decision-making in Prepectoral Direct-to-implant Reconstruction After Nipple Sparing Mastectomy: The Key Role of Flap Thickness Ratio

We report our experience in direct-to-implant breast reconstruction with prepectoral polyurethane implants, with a focus on intraoperative mastectomy flap thickness compared to preoperative data (flap thickness ratio) as a reliable predictive variable of ischemic complications and reconstructive outcomes (satisfaction with breast). BackgroundThe optimization of nipple sparing mastectomy and implant-based reconstruction techniques led to an increase in the popularity of prepectoral reconstruction. The aim of this study is to explore the ratio between the intraoperative and preoperative breast tissue coverage assessment as reliable tool in order to predict the risk of ischemic complications in prepectoral reconstruction. MethodsWe analyzed 124 preoperative digital mammograms of 100 patients who underwent prepectoral implant-based reconstruction. We applied a Rancati modified score for breast tissue coverage classification, adding 4 measurements on the craniocaudal view. The intraoperative mastectomy flap thickness was measured using an intraoperative ultrasound assessment. We investigated the differences between the groups with and without ischemic complications related to the preoperative, intraoperative, and flap thickness ratio data. ResultsThe flap thickness ratio was lower in ischemic complication group compared to no ischemic complication group (0.4 vs. 0.8) with statistically significant differences for all ischemic complication subgroups: major mastectomy flap necrosis (P = .000), minor mastectomy flap necrosis (P = .005), partial nipple areola complex necrosis (P = .007), and implant exposure (P = .001).

Immediate pre-pectoral breast reconstruction using acellular dermal matrix - Results from a single centre from United Kingdom

Introduction: Pre-pectoral implant-based reconstructions are a relatively recent addition to the armamentarium of implant-based reconstruction. There is emerging evidence regarding outcomes with paucity of long-term results. We report on outcomes of pre-pectoral implant-based reconstruction (IBR) from a single centre in the United Kingdom.

An 11-year Institutional Review of Nipple-Areolar Complex Tattooing for Breast Reconstruction: Identifying Risk Factors for Development of Tattoo-related Infectious Complications.

Nipple-areolar complex (NAC) tattooing remains a simple and safe procedure, which complements breast reconstruction. This study reviews 11 years of NAC tattooing to identify risk factors for tattoo-related complications. Patients undergoing NAC tattooing from January 2009 to March 2020 were reviewed. Patient information, reconstructive, and tattoo procedural details were analyzed. Tattoo-related breast infections, defined as breast redness requiring antibiotic therapy within 30 days after tattoo, were captured. Patients with reactive breast redness during the first 2 postprocedural days were excluded. Overall, 539 patients (949 breasts) were included. Implant-based reconstruction (IBR) was performed in 73.6% of breasts (n = 698), whereas 26.4% (n = 251) underwent autologous-based reconstruction (ABR). Acellular-dermal matrix was used in 547 breasts (57.6%). There as a 13.7% (n = 130) of breasts that underwent pretattoo radiation. There was a 65.3% (n = 456) of breasts that underwent subpectoral IBR, whereas 34.7% (n = 242) breasts underwent prepectoral IBR. Tattoo-related infection rate was 2.2% (n = 21 breasts). Mean time to infection was 6.5 ± 5.3 days. There was a 85.7% (n = 18) of infections that occurred in IBR patients, one third occurring in radiated patients. There was a 95.2% (n = 20) of infections that were treated with oral antibiotics only. One explantation was performed after failed intravenous antibiotics. On multivariable analysis, radiation history (odds ratio, 4.1, P = 0.007) and prepectoral IBR (odds ratio, 2.8, P = 0.036) were independent predictors of tattoo-related infection. Among irradiated breasts, breasts with IBR had greater odds of developing tattoo-related infection versus breasts with ABR (P = 0.025). Although tattoo-related infections were uncommon, previous radiation and prepectoral IBR were both found to be independent predictors of tattoo-related breast infection. There is a role for preprocedural prophylactic antibiotics in these patients to mitigate infectious risk.

Prepectoral implant-based breast reconstruction with TiLOOP® Bra Pocket – a single-centre retrospective study

BackgroundPrepectoral implant-based reconstruction using synthetic meshes is feasible with good outcomes. We present our data using TiLOOP® Bra Pocket, a novel ready-to-use mesh pocket which acts as an internal bra and prevents the implant from dislocating or twisting. Materials and MethodsA single-centre retrospective cohort study was performed to assess short-term complication rates and cosmetic outcomes in patients with prepectoral implant-based reconstruction using the TiLOOP® Bra Pocket. The primary endpoint was complication rates during the first 6 months. The secondary endpoint was the cosmetic outcome after 6 to 12 months, which was judged by two breast surgeons using the Harvard score. ResultsA total of 63 breasts (43 patients) were reconstructed using the TiLOOP® Bra Pocket between 2018 and 2020, 57 were immediate reconstructions. The overall complication rate was 30,2% (n = 19/63). Major complications occurred in seven breasts (n = 7/63; 11,1%) and minor complications occurred in 12 breasts (12/63; 19,0%). The unplanned revision rate was 12,7%. The cosmetic outcome was good (Harvard score: mean 3, range 1–4; SD 0,75). Seventeen cosmetic complications were observed (17/63; 27,0%) and six cosmetic revision surgeries were performed (6/63; 9,5%). ConclusionThe use of the TiLOOP® Bra Pocket is convenient and standardized because the pocket is preformed and does not require to be sewn first. Cosmetic outcome is good; however, the surgical morbidity needs to be addressed in future reconstructions. Careful patient selection and preparation techniques are vital in order to achieve acceptable complication rates and satisfying cosmetic results.

Advances in Tissue Expander Technology Enable Early Targeted Intervention in Prepectoral Breast Reconstruction.

Background:Seroma and infection are among the most common complications after staged prepectoral implant-based reconstruction. Advances in tissue expander technology permit seroma aspiration via an integrated drain port, thus, holding promise for improving clinical outcomes.Methods:A prospectively maintained database of patients who had undergone immediate prepectoral breast reconstruction using the Sientra AlloX2 tissue expander was used to determine the rate of postoperative seroma formation, its volume and microbiological spectrum, as well as postoperative complications.Results:49 patients (mean age: 49 years, mean body mass index: 24.5 kg/m2) underwent 79 prepectoral breast reconstructions. Seroma was clinically suspected in 26 reconstructions (32.9%) and was easily aspirated in all cases via the integrated drain port. Importantly, periprosthetic fluid was successfully aspirated in 45 reconstructions (57%) without any clinical evidence for seroma, with aspirated cumulative fluid volumes exceeding 10 cm3 in 12 reconstructions. Bacterial cultures from aspirated fluid were positive in six patients (12.2%), of whom two developed clinical signs of infection, at which point targeted antibiotic treatment was initiated.Conclusions:Our study demonstrates that routine office-based aspiration of periprosthetic fluid via the integrated drain port of the AlloX2 tissue expander not only permits successful aspiration of periprosthetic fluid but also allows aspirated fluid to be sent for culture, thus, providing a lead-time advantage for initiation of targeted antibiotic therapy in cases of postoperative surgical site infection. Furthermore, our observations indicate that positive bacterial cultures in the absence of clinical signs of infection do not mandate antibiotic therapy.

Day-case approach to immediate breast reconstruction: pushing the boundaries of ambulatory breast surgery in the post-COVID-19 era.

Day-case surgery is safe and efficacious for most breast surgical procedures. Limited data exist on its use in immediate breast reconstruction. We present our experience of day-case management of mastectomy with immediate pre-pectoral implant-based reconstruction (IBR). Data were collected on 47 patients who underwent day-case skin-sparing (SSM) or nipple-sparing (NSM) mastectomy with pre-pectoral IBR between October 2017 and September 2019. Clinicopathological data were collected, including postoperative complications, re-admission and re-operation. The data were compared to published national standards. Median age was 52 years (range 37-74). Thirty-two patients (68%) had an SSM and 15 (32%) had an NSM. Two patients (4%) had risk-reducing mastectomies and 45 had treatment for invasive cancer or ductal carcinoma in situ (DCIS). Mean tumour size was 33.3mm (range 7-85mm). Forty-two (89%) patients went home on the day of surgery. No patients required re-operation in the first 48 hours. The median postoperative follow-up time was 11.4 months (range 1.8-22.7 months). During the first 90-day postoperative period, eight patients (17%) developed superficial skin necrosis, five patients (10.6%) developed postoperative infections and five patients (10.6%) suffered an implant loss. Eight patients (17%) were readmitted for re-operation. Compared to UK national standards set in the iBRA study, our cohort has demonstrated comparable postoperative infection, implant loss and re-operation and re-admission rates. We have demonstrated close to 90% day-case success rate for mastectomy with IBR. These early data suggest that immediate IBR can be carried out in a manner that is cost-efficient without impacting surgical outcomes.

30. Short term outcome of pre-pectoral implant-based reconstruction versus sub-pectoral implant-based reconstruction using acellular dermal matrix

Introduction: Sub-pectoral implant reconstruction is associated with animation deformity and there is a recent interest in pre-pectoral implant reconstruction. The aim of our study was to compare the short-term outcome of pre-pectoral and sub-pectoral immediate implant-based reconstruction with ADM.

Abstract PS1-23: Pre-pectoral implant-based reconstruction and adjuvant radiation therapy - Surgical outcomes from a multicentre study in United Kingdom

Abstract BackgroundPre-pectoral implant-based reconstruction is the most common form of reconstruction performed in the United Kingdom (UK) after a mastectomy. Implant-based reconstruction is relatively contraindicated in patients known to require adjuvant radiation therapy. There is limited data on surgical outcomes in patients with pre-pectoral implant-based reconstruction who received adjuvant chest wall radiotherapy. We present early post-operative outcomes of in this subset of patients in a large multicentre audit on prepectoral implant based reconstruction. MethodsA retrospective multi-centre audit of all post-mastectomy prepectoral breast reconstruction (PBR) using Braxon® acellular dermal matrix was conducted. The demographic details, treatment details, 90-day complication rates and implant loss rates for the entire study period were evaluated. A subset analysis of patients who required adjuvant radiation therapy was performed. Complications were categorized as major and minor based on the Clavien-Dindo classification. All complications grade III or higher were regarded as major complications. Complications reported after 90 days of the reconstruction, were regarded as delayed complications. Implant loss rates were compared to the subset of patients who did not receive adjuvant radiation therapy. ResultsEight hundred and twenty two patients underwent 1020 post-mastectomy PBR across 29 centres in the UK from January 2014 to 2019. Of these, 166 (16.28%) reconstructions received adjuvant radiation therapy. Median follow-up period was 18 months for this cohort. Median age was 49 years and the median body mass index was 25 kg/m2. Fifty-six (33.73%) patients had an axillary nodal clearance. Median hospital stay was 1 day. One hundred and twenty eight (77.11%) patients had a single stage reconstruction and 93 (56%) patients received adjuvant chemotherapy. The 90-day major complication rate was 16.26%, readmission rate and return to theatre rate was 14.45% each. Delayed complications were reported in 8.43% patients. The implant loss rate was 7.83% for the entire study period. This was comparable to the implant loss rates in the subset of patients without adjuvant radiation therapy (p = 0.366). Patients with a 2-stage reconstruction had a higher major complication rate (22.71%) as compared to single stage reconstruction (16.40%), which was statistically not significant (p = 0.469). ConclusionImplant-based PBR with acellular dermal matrix has comparable outcomes in patients undergoing adjuvant radiation therapy in terms of early outcomes. Patient reported outcomes need to be evaluated along with incidence of capsular contractures and the possible needs for additional delayed surgical interventions in this group of patients. Larger studies are needed to confirm the findings and the impact of radiotherapy in PBR. CharacteristicNumber of patients or proceduresTotal number of procedures1020Procedures with adjuvant radiation therapy166 (16.27)Age (years)49BMI (kg/m2)25Management of axilla Axillary nodal clearance56 (33.73)Type of reconstructionOne-stage128 (77.11)Two-stage22 (13.25)Missing16 (9.64)Hospital stay (days)1 (0-10)Breast specimen weight (grams)452 (108-1578)Implant size (cc)400 (130-700)Adjuvant chemotherapy93 (56.02) Citation Format: Mihir Chandarana, Sankaran Narayanan, Rishikesh Parmeshwar. Pre-pectoral implant-based reconstruction and adjuvant radiation therapy - Surgical outcomes from a multicentre study in United Kingdom [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-23.

Abstract PS1-09: Long-term results of prepectoral implant-based reconstruction using braxon®acellular dermal matrix - national audit from United Kingdom

Abstract BackgroundSingle stage direct-to-implant reconstruction is the most common method of reconstruction in the United Kingdom (UK) after a mastectomy. Prepectoral implant placement with full implant coverage using acellular dermal matrix (ADM) is a relatively new technique with paucity of data on surgical outcomes. We report on long term outcomes of prepectoral breast reconstruction (PBR) using Braxon® ADM from a multicentre audit across the UKMethodsA retrospective multicentre audit of all direct-to-implant post-mastectomy PBR using Braxon® was conducted. The demographic details, treatment details, 90-day complication rates and implant loss rates for the entire study period were evaluated. Factors affecting major complication rates and implant loss rates were analysed using univariable and multivariable analysis.ResultsEight hundred and twenty two patients underwent 1020 post-mastectomy PBR across 29 centres in the UK from January 2014 to 2019. Median age of the cohort was 49 years with a median BMI of 25 kg/m2. The median and mean follow-up periods were 14 and 17.54 months respectively. The overall 90-day complication rate was 26.47% with major complications in 13.04% of patients. The 90-day readmission rate was 11.18% and return to theatre rate was 12.25%, with a 90-day implant loss rate of 5.1 percent. The implant loss rate was 6.28% for the entire study period. On multivariable analysis, therapeutic mastectomy (p = 0.008) and a higher breast specimen weight (p = 0.000) were the only factors to significantly impact major complications. Implant loss rates were significantly higher in current smokers (p = 0.000) and patients with previous breast radiation therapy (p = 0.010), axillary nodal clearance (p = 0.007), high breast specimen weight (p = 0.034) and a higher implant volume (p = 0.044) on multivariable analysis.ConclusionImplant-based prepectoral breast reconstruction with Braxon® acellular dermal matrix has satisfactory short-term and long-term operative outcomes, comparable to National data from the United Kingdom. Smoking, previous breast radiation therapy, axillary nodal clearance, high breast specimen weight and implant volume could negatively impact complications and implant loss rates. Patient-reported outcomes need to be evaluated. CharacteristicsNumber of patients or proceduresTotal number of patients822Total number of procedures1020Age (years)49BMI (kg/m2)25LateralityUnilateral624 (75.91)Bilateral198 (24.09)Smoker49 (4.80)Diabetes12 (1.17)Vascular disease11 (1.08)Previous breast surgery156 (15.30)Previous breast radiotherapy34 (3.33) Neoadjuvant chemotherapy122 (14.85)Reconstruction typeImmediate849 (83.23)Delayed25 (2.45)Missing146 (14.32)Management of axillaSentinel node biopsy457 (44.80)Axillary nodal clearance112 (10.98)None320 (31.37)Missing131 (12.85)Type of reconstructionOne-stage823 (80.68)Two-stage112 (10.98)Missing85 (8.34)Hospital stay (days)1 (0-10)Breast specimen weight (grams)391 (64-3900)Implant size (cc)385 (100-700)HistologyInvasive ductal carcinoma392 (38.43)Invasive lobular carcinoma47 (4.61)Ductal carcinoma in-situ167 (16.37)Lobular carcinoma in-situ11 (1.08)Not applicable276 (27.06)Missing127 (12.45)Adjuvant chemotherapy167 (20.32)Adjuvant radiation therapy166 (16.27) Citation Format: Mihir Chandarana, Sankaran Narayanan, Rishikesh Parmeshwar. Long-term results of prepectoral implant-based reconstruction using braxon®acellular dermal matrix - national audit from United Kingdom [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-09.

Complication Rate of Prepectoral Implant-based Breast Reconstruction Using Human Acellular Dermal Matrices.

Background:Implant-based breast reconstruction (IBR) is currently the most frequently performed reconstructive technique post mastectomy. Even though submuscular IBR continues to be the most commonly used technique, mastectomy technique optimization, the possibility to check skin viability with indocyanine green angiography, the enhanced propensity of patients undergoing prophylactic mastectomies, and the introduction of acellular dermal matrices (ADMs) have paved the way to the rediscovery of the subcutaneous reconstruction technique. The aim of this article is to update the complication rate of immediate and delayed prepectoral IBR using human ADMs (hADMs).Methods:A literature search, using PubMed, Medline, Cochrane, and Google Scholar database according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, was conducted to evaluate complication rates of prepectoral implant–based reconstructions using hADMs. The following MeSH terms were used: “prepectoral breast reconstruction acellular dermal matrix,” “prepectoral breast reconstruction ADM,” “human ADM breast reconstruction,” and “human acellular dermal matrix breast reconstruction” (period: 2005–2020; the last search took place on April 2, 2020).Results:This meta-analysis includes 1425 patients (2270 breasts) who had undergone immediate or delayed prepectoral IBR using different types of hADMs. The overall complication rate amounted to 19%. The most frequent complication was represented by infection (7.9%), followed by seroma (4.8%), mastectomy flap necrosis (3.4%), and implant loss (2.8%).Conclusions:The overall complication rate was 19%. The most frequent complications were infection, seroma, and mastectomy flap necrosis, while capsular contracture was rare.

20. IBREX: A PROSPECTIVE AUDIT OF EXAFLEX MESH IN IMMEDIATE, PRE-PECTORAL IMPLANT-BASED BREAST RECONSTRUCTION - PHASE 1 RESULTS

Introduction: Immediate pre-pectoral implant-based reconstruction with mesh following skin or nipple-sparing mastectomy has become a standard of care for women. EXAFLEX is a CE-marked bi-layered bovine pericardium-derived mesh with purse-string to facilitate rapid implant wrapping. Aims of this phase 1 audit are to examine safety in the first 20 patients. The primary endpoint is implant loss at 3 months compared to national quality standard and iBRA short-term outcomes of 5% and 9% respectively.

Negative Pressure Wound Therapy Reduces Wound Breakdown and Implant Loss in Prepectoral Breast Reconstruction.

Background:Single-use negative pressure wound therapy (NPWT) has been shown to encourage wound healing. It is often used when patient factors impair wound healing, or in more complex wounds, such as in implant-based breast reconstruction. We report the findings of a prospective cohort study comparing the use of NPWT with standard dressings in prepectoral breast reconstruction.Methods:A prospective database of implant-based reconstruction from a single institution was mined to identify patients who underwent prepectoral reconstruction. Patient demographics, operative data, surgical complications, and 90-day outcomes were compared between patients who had NPWT and those who had standard dressings.Results:Prepectoral implant-based breast reconstruction was performed on 307 breasts. NPWT dressings were used in 126 cases, with standard dressings used in 181 cases. Wound breakdown occurred in 10 cases after standard dressings versus 1 where NPWT was utilized. Of the standard dressing cases, only 3 implants were salvaged, while 7 cases led to implant loss. The 1 case of wound breakdown in the NPWT cohort settled with conservative measures. The cost of a reconstructive failure was £14,902, and the use of NPWT resulted in a cost savings of £426 per patient.Conclusions:The utilization of single-use NPWT reduces the rate of wound breakdown and implant loss in prepectoral implant-based reconstruction. In addition to the significant clinical benefits, this approach is cost-saving compared with standard dressings. These data suggest that prepectoral implant reconstruction should be considered as an indication for the use of NPWT.

Comparative Study of Immediate Complications and Implant Loss with Pre-Pectoral Implant-Based Reconstruction Versus Sub-Pectoral Implant-Based Reconstruction Using Biological Mesh

Comparative Study of Immediate Complications and Implant Loss with Pre-Pectoral Implant-Based Reconstruction Versus Sub-Pectoral Implant-Based Reconstruction Using Biological Mesh