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Multicenter Study
. 2020 Feb;4(1):71-77.
doi: 10.1002/bjs5.50236. Epub 2019 Dec 19.

Multicentre study of prepectoral breast reconstruction using acellular dermal matrix

M Chandarana  1 , S Harries  2 ; National Braxon Audit Study Group
Collaborators, Affiliations
Multicenter Study

Multicentre study of prepectoral breast reconstruction using acellular dermal matrix

M Chandarana et al. BJS Open. 2020 Feb.

Abstract
in English, Spanish

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.

Antecedentes: La reconstrucción en un tiempo es una técnica muy utilizada tras la mastectomía. La colocación de un implante prepectoral es una técnica relativamente novedosa. Esta auditoría multicéntrica analizó los resultados quirúrgicos después de la reconstrucción prepectoral utilizando una matriz dérmica acelular (acellular dermal matrix, ADM). MÉTODOS: Se incluyeron todas las pacientes en las que se efectuó una reconstrucción mamaria prepectoral y ADM tras la mastectomía en los centros participantes desde enero de 2015 hasta diciembre de 2017. Se analizaron los datos demográficos, detalles del tratamiento y los resultados operatorios a corto y a largo plazo. Se evaluaron los factores relacionados con las complicaciones y la pérdida del implante, incluyendo la edad, el índice de masa corporal, el tabaquismo, la diabetes, la enfermedad vascular, la lateralidad de la cirugía, la cirugía mamaria ipsilateral previa o la radioterapia previa, la indicación de cirugía (carcinoma invasivo versus carcinoma in situ o reducción del riesgo), el tipo de mastectomía, el vaciamiento axilar, el volumen mamario, el volumen del implante y la quimioterapia neoadyuvante y adyuvante.

Resultados: Se incluyeron 406 reconstrucciones efectuadas en 18 centros. La mediana de seguimiento fue de 9,65 meses. La mediana de la estancia hospitalaria fue de un día. La tasa de reingreso no planificado a los 90 días fue de 15,74% y la tasa de reoperaciones fue del 16,66%. Alrededor del 15% de las pacientes presentaron una complicación mayor, con una tasa de pérdida de implante del 4,93% a los 90 días. En otras 6 pacientes se retiró el implante con posterioridad. En el análisis multivariable no se identificó ningún factor que se asociara significativamente con la tasa de complicaciones o la pérdida del implante. CONCLUSIÓN: La reconstrucción mamaria prepectoral con ADM tiene resultados quirúrgicos satisfactorios. Se debe ampliar el periodo de seguimiento para analizar los resultados en pacientes tratadas con radioterapia adyuvante.

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Figures

Figure 1
Figure 1
Braxon® device assembly and surgical outcomes a Acellular dermal matrix (ADM) available as a preshaped template; b implant and ADM assembly; c placement of implant and ADM into the resection cavity. d Skin‐sparing mastectomy, before surgery; e 3 months after surgery; f 21 months after surgery. g Bilateral nipple‐sparing mastectomy, before surgery; h 1 month after surgery; i 8 months after surgery.
See this image and copyright information in PMC

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