Immediate breast reconstruction with acellular dermal matrix: Factors affecting outcome

Lardi, Alessia M.; Ho-Asjoe, Mark; Mohanna, Pari-Naz; Farhadi, Jian

doi:10.1016/j.bjps.2014.05.020

Cited by 80 publications

(77 citation statements)

References 32 publications

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“…Nonetheless, it is worth noting that the overall complication rate as well as implant loss frequency among Surgisis ® patients was considerably higher when a tissue expander was used than when an implant was used (47% vs. 26% and 25% vs. 8.6%, respectively, Table 2). Contrary to our findings, previous research has indicated that single-stage reconstruction might be a risk factor for complications when matrices/ meshes are used [21]. As the use of two-stage breast All tests are performed with univariable logistic regression.…”

Section: Discussioncontrasting

confidence: 88%

“…It has been postulated that the use of matrices in breast reconstruction might increase the risk of complications as they constitute a non-vascularised material in a setting with poorly circulated mastectomy flaps [6,7]. Indeed, the total early complication rate in this study was considerably higher than that in previously published studies involving the use of biologic matrices [21]. However, in previous studies, it is often unclear how the different complications were defined, which complications were included and how they were diagnosed [11].…”

Section: Discussionmentioning

confidence: 63%

“…Moreover, there were no demographic differences between the groups (Table 1), which supports that the two samples were similar. Secondly, muscle coverage is a method that has been used in our department for many years, whereas Surgisis ® was a new technique and, therefore, there could have been a learning curve [21], potentially leading to more complications in the Surgisis ® group. However, the results contradict that this was the case.…”

Section: Discussionmentioning

confidence: 99%

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Complications, long-term outcome and quality of life following Surgisis® and muscle-covered implants in immediate breast reconstruction: a case-control study with a 6-year follow-up

et al. 2018

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Background Matrices are now commonly used in breast reconstruction, but the scientific evidence is still scares. The main aim was to compare complications and the need for corrections in immediate breast reconstruction with the porcine-derived Surgisis ® with the traditional muscle-covered technique. The secondary aim was to compare long-term quality of life and satisfaction. Methods All consecutive patients who had their breast reconstructed with a Surgisis ® or muscle-covered tissue expander/implant were included. Patients were followed clinically and with BREAST-Q. Results During the study period, 116 reconstructions (71 patients) were operated in the Surgisis ® group and 132 reconstructions (90 patients) in the control group. The median follow-up time was 74 months (min 43-max 162). The total early complication rate was 37% in the Surgisis ® group and 27% in the control group. There were no differences in implant loss (p = 0.68) or total number of complications (p = 0.24) between the two groups. Risk factors for complications were mainly patient characteristics and the use of a tissue expander. There was a slightly higher capsular contracture frequency in the Surgisis ® patients (4.2% vs. 2.5%). The need for corrections and patient satisfaction and quality of life were similar in the two groups. Conclusions The use of Surgisis ® in implant-based reconstruction seems to result in an acceptable total early complication rate. The rate might be higher in tissue expander-based reconstruction. Risk factors are mainly patient characteristics. The capsular contracture rate and need for corrections, as well as patient satisfaction and quality of life, are similar in the Surgisis ® patients and muscle-covered controls. Level of evidence: III

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Section: Discussioncontrasting

confidence: 88%

Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

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Complications, long-term outcome and quality of life following Surgisis® and muscle-covered implants in immediate breast reconstruction: a case-control study with a 6-year follow-up

et al. 2018

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“…Moreover, evidence for the safety of ADM use in IBBR is also sparse, with contradictory results. Complication rates in published studies1, 5, 6, 7, 8 vary widely from 4·0 to 50·0 per cent. Reported complications include haematoma, seroma, infection, skin necrosis, flap or nipple ischaemia, and exposure of the ADM or implant5, 6, 7.…”

Section: Introductionmentioning

confidence: 99%

“…Complication rates in published studies1, 5, 6, 7, 8 vary widely from 4·0 to 50·0 per cent. Reported complications include haematoma, seroma, infection, skin necrosis, flap or nipple ischaemia, and exposure of the ADM or implant5, 6, 7. Several factors have been reported to increase the risk of complications, including age, smoking, BMI exceeding 30 kg/m 2 , periareolar incision, mastectomy weight over 600 g, and implant size larger than 600 ml5, 7, 9.…”

Section: Introductionmentioning

confidence: 99%

Predictors of complications after direct-to-implant breast reconstruction with an acellular dermal matrix from a multicentre randomized clinical trial

Negenborn

Dikmans

Bouman

et al. 2018

British Journal of Surgery

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BackgroundIn the multicentre randomized trial BRIOS (Breast Reconstruction In One Stage), direct‐to‐implant (DTI) breast reconstruction with an acellular dermal matrix (ADM) was associated with a markedly higher postoperative complication rate compared with two‐stage tissue expander/implant breast reconstruction. This study aimed to identify factors that contribute to the occurrence of complications after DTI ADM‐assisted breast reconstruction.MethodsData were obtained from the BRIOS study, including all patients treated with DTI ADM‐assisted breast reconstruction. Logistic regression analyses were performed to identify factors predictive of postoperative complications.ResultsFifty‐nine patients (91 breasts) were included, of whom 27 (35 breasts) developed a surgical complication. Reoperations were performed in 29 breasts (32 per cent), with prosthesis removal in 22 (24 per cent). In multivariable analyses, mastectomy weight was associated with complications (odds ratio (OR) 1·94, 95 per cent c.i. 1·33 to 2·83), reoperations (OR 1·70, 1·12 to 2·59) and removal of the implant (OR 1·55, 1·11 to 2·17). Younger patients (OR 1·07, 1·01 to 1·13) and those who received adjuvant chemotherapy (OR 4·83, 1·15 to 20·24) more frequently required reoperation. In univariable analyses, adjuvant radiotherapy showed a trend towards more complications (OR 7·23, 0·75 to 69·95) and removal of the implant (OR 5·12, 0·76 to 34·44), without reaching statistical significance.ConclusionBreast size appeared to be the most significant predictor of complications in DTI ADM‐assisted breast reconstruction. The technique should preferably be performed in patients with small to moderate sized breasts. Registration number: NTR5446 ( http://www.trialregister.nl).

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Acellular dermal matrices for breast reconstruction surgery

Rolph

Duffy

Mehta

et al. 2015

Cochrane Database of Systematic Reviews

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Immediate breast reconstruction with acellular dermal matrix: Factors affecting outcome

Cited by 80 publications

References 32 publications

Complications, long-term outcome and quality of life following Surgisis® and muscle-covered implants in immediate breast reconstruction: a case-control study with a 6-year follow-up

Complications, long-term outcome and quality of life following Surgisis® and muscle-covered implants in immediate breast reconstruction: a case-control study with a 6-year follow-up

Predictors of complications after direct-to-implant breast reconstruction with an acellular dermal matrix from a multicentre randomized clinical trial

Acellular dermal matrices for breast reconstruction surgery

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