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Erschienen in: European Journal of Plastic Surgery 5/2019

12.03.2019 | Original Paper

Outcomes of prepectoral implant-based breast reconstruction with Braxon® acellular dermal matrix—a single-centre experience

verfasst von: Mihir Chandarana, Soni Soumian, Sadaf Jafferbhoy, Sekhar Marla, Sankaran Narayanan

Erschienen in: European Journal of Plastic Surgery | Ausgabe 5/2019

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Abstract

Background

Single-stage direct-to-implant reconstruction is the most common method of reconstruction in the UK after a mastectomy. Prepectoral implant placement with full implant coverage using acellular dermal matrix (ADM) is a relatively new technique. We report on long-term outcomes of prepectoral immediate breast reconstruction (IBR) using Braxon® ADM from a single institution.

Methods

All patients operated for a mastectomy with IBR using Braxon® from January 2016 to March 2018 were included in the study. The demographic details, treatment details and short- and long-term outcomes were evaluated. Factors affecting complication rates were analysed. Patient-reported outcome measures were studied using BREAST-Q questionnaires.

Results

One hundred and sixteen reconstructions performed in 98 patients were included in the study. The median age was 50 years with a mean body mass index of 27.33 kg/m2. The median follow-up period was 440 days. The implant-related major complication rate was 17%, with an unplanned readmission rate of 22.4% and a return to theatre rate of 21.4%. Early complications were significantly higher in patients with node-positive disease. Delayed complications were seen in nine patients. The implant loss rate was 4.3%. The mean BREAST-Q scores were 78 for satisfaction with treatment and 64 for satisfaction with breast domains. The outcomes were comparable to reported national data.

Conclusions

Prepectoral implant-based reconstruction with Braxon has comparable complication rates with good long-term aesthetic and patient-reported outcomes. Further studies with larger cohort and longer follow-up are needed.
Level of Evidence—Level III, therapeutic study.
Literatur
1.
Zurück zum Zitat Mennie JC, Mohanna P-N, O’Donoghue JM, Rainsbury R, Cromwell DA (2017) National trends in immediate and delayed post-mastectomy reconstruction procedures in England: a seven-year population-based cohort study. Eur J Surg Oncol 43(1):52–61CrossRefPubMed Mennie JC, Mohanna P-N, O’Donoghue JM, Rainsbury R, Cromwell DA (2017) National trends in immediate and delayed post-mastectomy reconstruction procedures in England: a seven-year population-based cohort study. Eur J Surg Oncol 43(1):52–61CrossRefPubMed
2.
Zurück zum Zitat Spear SL, Schwartz J, Dayan JH, Clemens MW (2009) Outcome assessment of breast distortion following submuscular breast augmentation. Aesthetic Plast Surg 33(1):44–48CrossRefPubMed Spear SL, Schwartz J, Dayan JH, Clemens MW (2009) Outcome assessment of breast distortion following submuscular breast augmentation. Aesthetic Plast Surg 33(1):44–48CrossRefPubMed
3.
Zurück zum Zitat Hammond DC, Schmitt WP, O’Connor EA (2015) Treatment of Breast Animation Deformity in Implant-Based Reconstruction with Pocket Change to the Subcutaneous Position. Plast Reconstr Surg 135(6):1540–1544 Hammond DC, Schmitt WP, O’Connor EA (2015) Treatment of Breast Animation Deformity in Implant-Based Reconstruction with Pocket Change to the Subcutaneous Position. Plast Reconstr Surg 135(6):1540–1544
4.
5.
Zurück zum Zitat Baker BG, Irri R, MacCallum V, Chattopadhyay R, Murphy J, Harvey JRA (2018) Prospective comparison of short-term outcomes of subpectoral and prepectoral Strattice-based immediate breast reconstruction. Plast Reconstr Surg 141(5):1077–1084CrossRefPubMed Baker BG, Irri R, MacCallum V, Chattopadhyay R, Murphy J, Harvey JRA (2018) Prospective comparison of short-term outcomes of subpectoral and prepectoral Strattice-based immediate breast reconstruction. Plast Reconstr Surg 141(5):1077–1084CrossRefPubMed
6.
Zurück zum Zitat Berna G, Cawthorn SJ, Papaccio G, Balestrieri N (2017) Evaluation of a novel breast reconstruction technique using the Braxon® acellular dermal matrix: a new muscle-sparing breast reconstruction. ANZ J Surg 87(6):493–498CrossRefPubMed Berna G, Cawthorn SJ, Papaccio G, Balestrieri N (2017) Evaluation of a novel breast reconstruction technique using the Braxon® acellular dermal matrix: a new muscle-sparing breast reconstruction. ANZ J Surg 87(6):493–498CrossRefPubMed
7.
Zurück zum Zitat Kobraei EM, Cauley R, Gadd M, Austen WG, Liao EC (2016) Avoiding breast animation deformity with pectoralis-sparing subcutaneous direct-to-implant breast reconstruction. Plast Reconstr Surg Glob Open 4(5):e708CrossRefPubMedPubMedCentral Kobraei EM, Cauley R, Gadd M, Austen WG, Liao EC (2016) Avoiding breast animation deformity with pectoralis-sparing subcutaneous direct-to-implant breast reconstruction. Plast Reconstr Surg Glob Open 4(5):e708CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Raghavan V, Jaume M, Simon C, Giorgio B, Fernando B, Alexander G et al (2017) Evaluation of the effectiveness of the prepectoral breast reconstruction with Braxon dermal matrix: first multicenter European report on 100 cases. Breast J 23(6):670–676CrossRef Raghavan V, Jaume M, Simon C, Giorgio B, Fernando B, Alexander G et al (2017) Evaluation of the effectiveness of the prepectoral breast reconstruction with Braxon dermal matrix: first multicenter European report on 100 cases. Breast J 23(6):670–676CrossRef
10.
Zurück zum Zitat Jafferbhoy S, Chandarana M, Houlihan M, Parmeshwar R, Narayanan S, Soumian S, Harries S, Jones L, Clarke D (2017) Early multicentre experience of pre-pectoral implant based immediate breast reconstruction using Braxon®. Gland Surg 6(6):682–688CrossRefPubMedPubMedCentral Jafferbhoy S, Chandarana M, Houlihan M, Parmeshwar R, Narayanan S, Soumian S, Harries S, Jones L, Clarke D (2017) Early multicentre experience of pre-pectoral implant based immediate breast reconstruction using Braxon®. Gland Surg 6(6):682–688CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat Casella D, Bernini M, Bencini L, Roselli J, Lacaria MT, Martellucci J, Banfi R, Calabrese C, Orzalesi L (2014) TiLoop® bra mesh used for immediate breast reconstruction: comparison of retropectoral and subcutaneous implant placement in a prospective single-institution series. Eur J Plast Surg 37(11):599–604CrossRefPubMedPubMedCentral Casella D, Bernini M, Bencini L, Roselli J, Lacaria MT, Martellucci J, Banfi R, Calabrese C, Orzalesi L (2014) TiLoop® bra mesh used for immediate breast reconstruction: comparison of retropectoral and subcutaneous implant placement in a prospective single-institution series. Eur J Plast Surg 37(11):599–604CrossRefPubMedPubMedCentral
13.
Zurück zum Zitat Martin L, O’Donoghue JM, Horgan K, Thrush S, Johnson R, Gandhi A (2013) Association of Breast Surgery and the British Association of Plastic, reconstructive and aesthetic surgeons. Acellular dermal matrix (ADM) assisted breast reconstruction procedures: joint guidelines from the Association of Breast Surgery and the British Association of Plastic, reconstructive and aesthetic surgeons. Eur J Surg Oncol 39:425–429CrossRefPubMed Martin L, O’Donoghue JM, Horgan K, Thrush S, Johnson R, Gandhi A (2013) Association of Breast Surgery and the British Association of Plastic, reconstructive and aesthetic surgeons. Acellular dermal matrix (ADM) assisted breast reconstruction procedures: joint guidelines from the Association of Breast Surgery and the British Association of Plastic, reconstructive and aesthetic surgeons. Eur J Surg Oncol 39:425–429CrossRefPubMed
14.
Zurück zum Zitat Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentral Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Berna G, Cawthorn SJ (2017) Long term follow-up on prepectoral ADM-assisted breast reconstruction: evidences after 4 years. Eur J Plast Surg 40(3):255–258CrossRef Berna G, Cawthorn SJ (2017) Long term follow-up on prepectoral ADM-assisted breast reconstruction: evidences after 4 years. Eur J Plast Surg 40(3):255–258CrossRef
17.
Zurück zum Zitat Browne J, Pereira J, Caddy C, Sheppard C, Nurse BC. British association of plastic, Reconstructive and Aesthetic Surgeons Browne J, Pereira J, Caddy C, Sheppard C, Nurse BC. British association of plastic, Reconstructive and Aesthetic Surgeons
19.
Zurück zum Zitat Ho G, Nguyen TJ, Shahabi A, Hwang BH, Chan LS, Wong AK (2012) A systematic review and meta-analysis of complications associated with acellular dermal matrix-assisted breast reconstruction. Ann Plast Surg 68:346–356 Ho G, Nguyen TJ, Shahabi A, Hwang BH, Chan LS, Wong AK (2012) A systematic review and meta-analysis of complications associated with acellular dermal matrix-assisted breast reconstruction. Ann Plast Surg 68:346–356
21.
Zurück zum Zitat Negenborn VL, Dikmans REG, Bouman M-B, Wilschut JA, Mullender MG, Salzberg CA (2018) Patient-reported outcomes after ADM-assisted implant-based breast reconstruction: a cross-sectional study. Plast Reconstr Surg Glob Open 6(2):e1654CrossRefPubMedPubMedCentral Negenborn VL, Dikmans REG, Bouman M-B, Wilschut JA, Mullender MG, Salzberg CA (2018) Patient-reported outcomes after ADM-assisted implant-based breast reconstruction: a cross-sectional study. Plast Reconstr Surg Glob Open 6(2):e1654CrossRefPubMedPubMedCentral
22.
Zurück zum Zitat Sedgwick P (2014) Retrospective cohort studies: advantages and disadvantages. BMJ 348(jan24 1):g1072–g1072CrossRef Sedgwick P (2014) Retrospective cohort studies: advantages and disadvantages. BMJ 348(jan24 1):g1072–g1072CrossRef
Metadaten
Titel
Outcomes of prepectoral implant-based breast reconstruction with Braxon® acellular dermal matrix—a single-centre experience
verfasst von
Mihir Chandarana
Soni Soumian
Sadaf Jafferbhoy
Sekhar Marla
Sankaran Narayanan
Publikationsdatum
12.03.2019
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Plastic Surgery / Ausgabe 5/2019
Print ISSN: 0930-343X
Elektronische ISSN: 1435-0130
DOI
https://doi.org/10.1007/s00238-019-01512-2

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