Outcome of the use of acellular-dermal matrix to assist implant-based breast reconstruction in a single centre

M. D. Barber, L. Williams, E. D. C. Anderson, G. T. Neades, C. Raine, O. Young, D. Kulkarni, I. Young, J. M. Dixon

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: The use of acellular dermal matrix (ADM) has transformed the technique of implant-based breast reconstruction. It offers the option of a one-stage procedure and is felt to have benefits in cosmetic outcome but the medium and long-term outcomes are unknown.

Methods: All cases where ADM was used in a breast reconstructive procedure in the Edinburgh Breast Unit from its initial use on 7/7/2008 to 31/7/2012 were reviewed retrospectively. Follow up was completed to 30/11/2012.

Results: 147 patients received 232 sheets of ADM (156 Strattice, 73 Permacol and 3 Alloderm). Mean follow up was 687 days. In 40 cases unplanned implant explantation occurred (17.2% or 27.2% of patients). 7 of 27 (25.9%) patients requiring adjuvant therapy had this delayed due to problems with the reconstruction. 30 of 80 patients (37.5%) undergoing unilateral surgery have undergone contralateral surgery. Implant loss varied significantly with smoking (34.6% loss rate in smokers vs 13.2% in non-smokers, p = 0.001), with radiotherapy (28.1% loss rate vs 13.8% with no radiotherapy, p = 0.001) and with incision type. There was no statistically significant variation by operating surgeon, type of ADM used, chemotherapy use, patient weight, breast weight or nipple preservation. Patients underwent a mean of 1.54 further operations (range 0-7).

Conclusions: While offering potential cosmetic and financial benefits, the use of ADM with implant-based reconstructions has a significant rate of implant loss, further surgery and potential delay in adjuvant therapy. These must be considered when planning treatment and consenting patients. (C) 2014 Elsevier Ltd. All rights reserved.

Original languageEnglish
Pages (from-to)100-105
Number of pages6
JournalEJSO - European Journal of Surgical Oncology
Volume41
Issue number1
Early online date6 Sep 2014
DOIs
Publication statusPublished - Jan 2015

Keywords

  • Breast
  • Mastectomy
  • Breast reconstruction
  • Acellular dermal matrix
  • Surgical complications
  • PATIENT SATISFACTION
  • EXPANDER IMPLANTS
  • COMPLICATIONS
  • METAANALYSIS
  • MULTICENTER

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