H. K. Kankam1, G. J. Hourston1, L. J. Fopp2, A. A. Agrawal3, S. L. Benyon2, M. S. Irwin2, P. Forouhi3, J. R. Benson3,4, C. M. Malata2,3,4 1University Of Cambridge,School Of Clinical Medicine,Cambridge, CAMBRIDGESHIRE, United Kingdom 2Cambridge University Hospitals NHS Trust,Department Of Plastic Surgery,Cambridge, CAMBRIDGESHIRE, United Kingdom 3Cambridge University Hospitals NHS Trust,Cambridge Breast Unit,Cambridge, CAMBRIDGESHIRE, United Kingdom 4Anglia Ruskin University , Cambridge And Chelmsford,Postgraduate Medical Institute, Faculty Of Health Sciences,Cambridge, CAMBRIDGESHIRE, United Kingdom
Introduction:
Reconstructive breast surgery has evolved in the UK over the last decade with a doubling of the immediate reconstruction rate and the introduction of acellular dermal matrices (ADM). The reported advantages of ADMs (in optimising aesthetic outcome, providing inferolateral implant coverage and decreasing radiation-induced capsular contracture) have resulted in their adoption by plastic surgeons and their increased use in implant-based procedures. This study assesses the temporal and practice-changing impact of ADM on the types of post-mastectomy reconstructions performed in our Unit and the outcomes of implant-only techniques.
Methods:
We conducted a retrospective chart review of all patients undergoing post-mastectomy breast reconstruction at a University Teaching Hospital 18 months before and after adoption of ADM (21/10/2013). Patients were identified from the Unit’s reconstruction diary and plastic surgery theater registers. Demographic, procedural as well as complication data were collected for these two patient cohorts and compared.
Results:
Over the three year period a total of 266 reconstruction patients (340 breasts) with a mean age of 47.5 years were identified; 137 (166 breasts) before and 129 (174 breasts) following introduction of ADM. Reconstructions included autologous tissue-only (44%), implant-only (35%) and combined (21%) techniques. Implant-only procedures increased from 16% to 53% following the advent of ADM (p<0.01, Chi-square test). The indications for all reconstructions were cancer (69%), risk-reduction (26%), salvage of prior surgeries (4%), and others including burns (1%). For the immediate reconstructions (cancer and risk-reduction groups), there were proportionally more implant-only procedures after the advent of ADMs. The proportion of latissmus dorsi (LD) flap reconstructions decreased after the introduction of ADMs (from 31% to 11%, p<0.01, Chi-square test) as did that of deep inferior epigastric perforator (DIEP) flaps (from 49% to 33%, p<0.01, Chi-square test).
The complications we reviewed (infection, wound breakdown, haematoma, seroma and capsular contracture) for the implant-only procedures were not significantly different whether or not an ADM was used (27% versus 19% without ADM, p=0.38 Chi-square test). The number of implant-only reconstructions that received adjuvant radiotherapy after the introduction of ADM did not differ significantly from that before (20% versus 17% respectively, p=0.83 Chi-square test).
Conclusion:
The present study showed that since ADM introduction to our centre, more breast reconstructions have been of the implant-only type with consequent reductions in the more expensive autolougous techniques. ADM use in post-mastectomy reconstruction has not resulted in increased complications contrary to widespread anecdotal reports. The possibility of post-operative radiotherapy was not seen as a total contraindication for implant-based reconstruction.