Establishing an equipoise: Does the use of acellular dermal matrices in pre-pectoral implant-based breast reconstruction improve outcomes?

Autor: Cook H; Department of Plastic Surgery, Royal Free Hospital, UK; University College Hospital Division of Surgery and Interventional Science, UK. Electronic address: hannah.cook31@nhs.net., Zargaran D; Department of Plastic Surgery, Royal Free Hospital, UK; University College Hospital Division of Surgery and Interventional Science, UK., Glynou SP; Department of Plastic Surgery, Royal Free Hospital, UK; Imperial College London School of Medicine, UK., Zargaran A; Department of Plastic Surgery, Royal Free Hospital, UK; University College Hospital Division of Surgery and Interventional Science, UK., Akhavani M; Department of Plastic Surgery, Royal Free Hospital, UK., Williams N; University College Hospital Division of Surgery and Interventional Science, UK., Hamilton S; Department of Plastic Surgery, Royal Free Hospital, UK; University College Hospital Division of Surgery and Interventional Science, UK., Mosahebi A; Department of Plastic Surgery, Royal Free Hospital, UK; University College Hospital Division of Surgery and Interventional Science, UK.
Jazyk: angličtina
Zdroj: Journal of plastic, reconstructive & aesthetic surgery : JPRAS [J Plast Reconstr Aesthet Surg] 2024 Dec; Vol. 99, pp. 23-29. Date of Electronic Publication: 2024 Sep 17.
DOI: 10.1016/j.bjps.2024.09.041
Abstrakt: Introduction: Breast cancer is the most common malignancy among women in the United Kingdom. Surgical management commonly comprises mastectomy and reconstruction, of which implant-based breast reconstruction (IBBR) is the most prevalent. Acellular dermal matrices (ADM) are widely used in pre-pectoral IBBR; however, there is limited high-quality evidence supporting their efficacy. This study aimed to establish an equipoise via an expert consensus survey.
Methods: An online survey was designed with a steering group of experts. Questions covered participant information, opinions regarding surgical outcomes with ADM use in pre-pectoral IBBR and opinions regarding the available scientific evidence on the topic. The survey was advertised via national and international professional organisations. Quantitative and qualitative analyses were performed.
Results: Thirty-two participants from the UK, Italy and Australia completed the survey. Key findings of this study included disagreement among participants regarding the surgical outcomes associated with ADM use. Participants who believed that ADM reduced the risk of short-term complications and implant failure/explantation comprised a minority (21.9%). Participants who felt that ADM use improved cosmetic outcomes and reduced long-term complications were a relative majority at 43.8% and 40.6%, respectively. Furthermore, 56.3% of the participants felt that there was scarce scientific evidence on the topic.
Conclusions: This study provides insights from international surgeons, establishing a lack of consensus on surgical outcomes, efficacy and evidence-base supporting the use of ADMs in pre-pectoral IBBR. Given this clinical equipoise, alongside the growing burden of breast cancer associated morbidity and need for reconstruction, the implications of this study are that large-scale, prospective, randomised-controlled data are needed to establish whether ADM use in pre-pectoral breast reconstruction improves the outcomes.
(Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: