Abstract P3-14-05: Long term risk of explantation with Strattice™ assisted breast reconstruction, is it any different to submuscular reconstruction?

Abstract

Introduction The most recent meta-analysis published, containing only studies from 2011 onwards, reports acellular dermal matrix (ADM) assisted breast reconstructions are associated with a significant increase in risk of infection, seroma and mastectomy flap necrosis but not implant loss when compared to submuscular reconstructions. We hypothesised that implant loss associated with ADM-assisted reconstruction did not exclusively occur within the first 30 days after surgery and studies with short-term follow-up may underestimate the risk. We aimed to determine with long-term follow-up at what time point explantation occurs after Strattice™ ADM-assisted reconstruction and if it differs from traditional submuscular implant based reconstruction. Methods A retrospective case note review was completed for all immediate implant based reconstructions performed between 1st January 2009 and 31st December 2015 in a single tertiary centre in England. Implant losses, the timings and causes of loss were determined. Results In total there were 510 immediate implant based reconstructions performed in 373 patients, of which 135 were submuscular and 375 ADM-assisted. In the ADM group a total of 22 (5.9%) implants were lost as a complication of their primary surgery. 14 implants were lost due to infection and eight due to wound breakdown. Implants were lost over a range of 14-661 days, median 76 days. Implant loss occurred within 30 days in six (27%), <90 days in 13 (59%) and over 90 days in nine breasts (41%). There were seven unplanned explantations, six were changed to autologous reconstructions (three for cosmetic reasons and three as a result of radiotherapy damage); one patient had a completion mastectomy for recurrent cancer. In the submuscular group a total of 11 (8.1%) implants were lost as a complication of their primary surgery. Six implants were lost due to infection and five due to wound breakdown. Implants were lost over a range of 12-274 days, median 49 days. Implant loss occurred within 30 days in four (36%), <90 days in seven (64%) and over 90 days in nine breasts (36%). There were a further six unplanned explantations, two for pain and four for cosmetic reasons. Comparing the two groups there were no differences in total implant loss rate or time to implant loss. Conclusions Implant loss within the first 3 months of ADM-assisted breast reconstruction is 3.5%; however, implant loss can occur more than 90 days after ADM-assisted breast reconstruction. Patients and clinicians should be aware that the risk of explantation continues for up to two years post-operatively with an ADM-assisted reconstruction whereas with submuscular coverage there were no implant losses beyond nine months follow-up. There were no differences in explantation rates between submuscular and ADM-assisted breast reconstructions. Citation Format: Wilson RL, Kirwan CC, Johnson RK, Harvey JR. Long term risk of explantation with Strattice™ assisted breast reconstruction, is it any different to submuscular reconstruction? [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-14-05.