Trends in post-mastectomy breast reconstruction types at a breast cancer tertiary referral centre before and after introduction of acellular dermal matrices

Kankam, Hadyn; Hourston, George; Fopp, Laura J.; Benson, John R.; Benyon, Sarah; Irwin, Michael S.; Agrawal, Amit; Forouhi, Parto; Malata, Charles M.

doi:10.1016/j.bjps.2017.08.016

Cited by 12 publications

(10 citation statements)

References 24 publications

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“…1 However, compared with implant-based reconstruction, autologous tissue transfer is associated with longer operative times, longer hospital length of stay, and higher intraoperative blood loss which can require blood transfusion in the perioperative period. 2,3 Transfusion in patients undergoing autologous free tissue transfer for breast reconstruction occurs at rates up to 8%. 4 Perioperative resuscitation strategies have been in the spotlight in many different surgical specialties with conflicting conclusions.…”

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confidence: 99%

Impact of Blood Transfusion in Free Flap Breast Reconstruction Using Propensity Score Matching

Karamanos

Shah

Kim

et al. 2020

J Reconstr Microsurg

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Background Microvascular thrombosis has been associated with cytokine release and inflammatory syndromes which can occur as a result of blood transfusions. This phenomenon could potentially lead to complications in breast free flap reconstruction. The aim of this study was to evaluate the impact of perioperative blood transfusion in free flap breast reconstruction using large population analysis. Methods The American College of Surgeons National Quality Improvement Program database was queried for delayed free flap breast reconstructions performed in 2016. The study population was divided based on perioperative blood transfusion within 24 hours of the start of the operation. Propensity score matching analysis was used to ensure homogeneity between the two study groups. Primary outcome was unplanned return to the operating room (OR) within 30 days. Secondary outcomes were readmission and complications. Results A total of 1,256 patients were identified. Out of those, 91 patients received a perioperative blood transfusion. All the patients received only one unit of PRBC within the first 24 hours. Those patients were matched with similar patients who did not receive a transfusion on a ratio of 1:3 (273 patients). Patients who received a transfusion had a significantly higher incidence of reoperation (42 vs. 10%, p < 0.001). Patients who received a transfusion were more likely to return to the OR after 48 hours from the initial operation (13 vs. 5%, p = 0.001). All returns to the OR were due to flap-related complications. Perioperative blood transfusion increased the incidence of wound dehiscence (9 vs. 2%, p = 0.041) but had no protective effect on the development of other postoperative complications. Conclusion Perioperative blood transfusion in free flap breast reconstruction is associated with an increased probability of flap-related complications and subsequent return to the OR without decreasing the probability of developing other systemic postoperative complications.

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confidence: 99%

Impact of Blood Transfusion in Free Flap Breast Reconstruction Using Propensity Score Matching

Karamanos

Shah

Kim

et al. 2020

J Reconstr Microsurg

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“…These rates are in accordance with previous series involving experienced surgeons, which reported 2.6% epidermolysis rates and 1.3% full skin flap necrosis, 8,9 results mirrored by another study with a workload of 30 reconstructions/surgeon/year. 10 A randomized controlled trial including 92 reconstructions had very low rates of infection (2%) and skin necrosis (1%). 11 The present study benefits from its single-surgeon We conclude that future studies should include a minimum workload/surgeon/year or provide this information.…”

Section: Association Between Variables Was Evaluated By Chi-squared Tmentioning

confidence: 99%

“…The complication rates lie below the 5% threshold, except for seroma formation (14%). These rates are in accordance with previous series involving experienced surgeons, which reported 2.6% epidermolysis rates and 1.3% full skin flap necrosis, results mirrored by another study with a workload of 30 reconstructions/surgeon/year . A randomized controlled trial including 92 reconstructions had very low rates of infection (2%) and skin necrosis (1%) .…”

Section: Patient Tumor and Treatment Characteristicsmentioning

confidence: 99%

Acellular dermal matrices safety in breast reconstruction—Is it truly associated with higher rates of complications? A large single‐surgeon cohort analysis

Vasconcelos

Siedentopf²,

Schoenegg³

2020

Breast J

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“…It was not a surprise that Kankam HKN, et al in January 2018 [4] reported that in 264 patients over the last 18 months the ADM-assisted IBBR percentage has increased from 16% to 52% of all breast reconstruction procedures, stepping down the DIEP from 49% to 34%. Which can be a sign of a pending shift in the breast reconstruction in the following years.…”

Section: Clinical Scenariomentioning

confidence: 99%

ADM-Assisted Implant Based Breast Reconstruction vs. Free Tissue Transfer Breast Reconstruction

Mohammad¹

2022

Clin Med Rev Case Rep

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Original articleCheck for updates sparing mastectomy for breast cancer with expected postoperative radiotherapy, will a free tissue transfer e.g., DIEP breast reconstruction or Implant based + ADM breast reconstruction yield a better outcome in terms of patient satisfaction, cost effectiveness and risks? Search StrategyMedline 2008-April 2018 using the pubmed interface [(exp Breast reconstruction) AND ADM AND Implant LIMIT to English. Search Outcome141 papers were found. Of which 121 publications in the last 5 years, only 61 were relative to humans. of these were excluded as they were non relevant to the reconstructive approach. Remaining 19 publications were included (Table 2). CommentBreast reconstruction has been evolving fast for the past few decades. Recently the free tissue transfer has been the gold standard in Breast reconstruction replacing the Implant based breast reconstruction (IBBR) in most of the world, providing reliable, autologous, safe and, most importantly, durable tissue that handles the common peri-operative radiotherapy reliably.

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Trends in post-mastectomy breast reconstruction types at a breast cancer tertiary referral centre before and after introduction of acellular dermal matrices

Cited by 12 publications

References 24 publications

Impact of Blood Transfusion in Free Flap Breast Reconstruction Using Propensity Score Matching

Impact of Blood Transfusion in Free Flap Breast Reconstruction Using Propensity Score Matching

Acellular dermal matrices safety in breast reconstruction—Is it truly associated with higher rates of complications? A large single‐surgeon cohort analysis

ADM-Assisted Implant Based Breast Reconstruction vs. Free Tissue Transfer Breast Reconstruction

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