Porcine acellular dermis-based breast reconstruction: complications and outcomes following adjuvant radiotherapy

Ng, Cho Ee; Pieri, Andrew; Fasih, Tarannum

doi:10.1007/s00238-015-1130-1

Cited by 16 publications

(15 citation statements)

References 17 publications

(19 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Radiotherapy, before or after implant reconstruction has also been shown to lead to high rates of capsular contracture and decreased patient satisfaction [36] . Recent data to suggest that ADM may offer protection against the adverse effects of radiotherapy [37] , [38] may explain why the majority of centres do not consider this to be a contraindication to mesh-assisted IBBR. Data to support the proposed benefits, however are limited [39] .…”

Section: Discussionmentioning

confidence: 99%

Variation in the provision and practice of implant-based breast reconstruction in the UK: Results from the iBRA national practice questionnaire

Williamson¹,

Cutress²,

Gardiner³

et al. 2017

The Breast

View full text Add to dashboard Cite

IntroductionThe introduction of biological and synthetic meshes has revolutionised the practice of implant-based breast reconstruction (IBBR) but evidence for effectiveness is lacking. The iBRA (implant Breast Reconstruction evAluation) study is a national trainee-led project that aims to explore the practice and outcomes of IBBR to inform the design of a future trial. We report the results of the iBRA National Practice Questionnaire (NPQ) which aimed to comprehensively describe the provision and practice of IBBR across the UK.MethodsA questionnaire investigating local practice and service provision of IBBR developed by the iBRA Steering Group was completed by trainee and consultant leads at breast and plastic surgical units across the UK. Summary data for each survey item were calculated and variation between centres and overall provision of care examined.Results81 units within 79 NHS-hospitals completed the questionnaire. Units offered a range of reconstructive techniques, with IBBR accounting for 70% (IQR:50–80%) of participating units' immediate procedures. Units on average were staffed by 2.5 breast surgeons (IQR:2.0–3.0) and 2.0 plastic surgeons (IQR:1.0–3.0) performing 35 IBBR cases per year (IQR:20-50). Variation was demonstrated in the provision of novel different techniques for IBBR especially the use of biological (n = 62) and synthetic (n = 25) meshes and in patient selection for these procedures.ConclusionsThe iBRA-NPQ has demonstrated marked variation in the provision and practice of IBBR in the UK. The prospective audit phase of the iBRA study will determine the safety and effectiveness of different approaches to IBBR and allow evidence-based best practice to be explored.

show abstract

Section: Discussionmentioning

confidence: 99%

Variation in the provision and practice of implant-based breast reconstruction in the UK: Results from the iBRA national practice questionnaire

Williamson¹,

Cutress²,

Gardiner³

et al. 2017

The Breast

View full text Add to dashboard Cite

show abstract

“…We read the study by Ng and colleagues [1] with great interest. In their study, the authors report on the use of an acellular dermal matrix (ADM, Strattice™, LifeCell, NJ, USA) in the setting of breast reconstruction and radiotherapy treatment.…”

Section: Sirmentioning

confidence: 95%

Porcine acellular dermis-based breast reconstruction: complications and outcomes following adjuvant radiotherapy

et al. 2016

View full text Add to dashboard Cite

Sir,We read the study by Ng and colleagues [1] with great interest. In their study, the authors report on the use of an acellular dermal matrix (ADM, Strattice™, LifeCell, NJ, USA) in the setting of breast reconstruction and radiotherapy treatment. In their study, Ng and colleagues describe an overall complication rate of 32 % with no significant difference between those treated with radiotherapy before surgery and those treated postoperatively. They therefore conclude that implant-based reconstruction using Strattice™ should not be an absolute contraindication in pre-or post-radiotherapy patients, but that the increased risks are emphasised to patients in order to better manage patient expectations if complications arise.With up to one third of women opting for mastectomy [2], the use of ADMs in breast reconstruction is becoming increasingly popular, being described as the most significant innovation impacting prosthetic breast reconstruction in recent years [3]. We recently undertook a similar study, looking at the use of a bovine-derived ADM, SurgiMend™ (TEI Biosciences, MA, USA), in a prospective case series of 118 patients undergoing 164 skin sparing mastectomy and immediate reconstruction procedures. Thirty-two patients (27 %) in our series underwent radiotherapy, of whom 27 received postmastectomy radiotherapy and 5 received it prior to surgery. Fifty-two percent of the patients received chemotherapy.Despite this relatively high uptake rate of chemotherapy and radiotherapy, we found a relatively low complication rate. At a mean follow-up of 21 months, the explantation rate was 1.2 %, and 4 % of patients developed wound complications. This included one case of partial wound dehiscence requiring surgical debridement and implant replacement in a patient who had undergone both postmastectomy radiotherapy and chemotherapy. Another patient who also received radiotherapy prior to surgery developed capsular contracture after 2 years which required capsulotomy and fat transfer. Those who lost their implants were undergoing adjuvent chemotherapy. We also found that there was high patient satisfaction with the outcome of the procedure (9 out of 10).We therefore agree with the conclusions reached by Ng and colleagues: ADM-assisted breast reconstruction should not be an absolute contraindication in patients receiving radiotherapy. The difference between results may be explained by differences in surgical technique or the different ADMs used in each of the studies, as follow-up times were similar. Furthermore, other factors have been reported to affect complication rate, such as body mass and comorbidity status; therefore, patient selection may also play a role. As Ng rightly point out, it is important to ensure that patients have adequate

show abstract

“…The generic reference to ‘breast reconstruction’ was intended to capture all articles addressing the type and timing of breast reconstruction. Two authors independently reviewed abstracts of all studies published between 1985 and 2014, and the full texts of those studies published in 2015–2017. Levels of clinical evidence (LoE) were evaluated for each publication and scored from I to V by employing Oxford criteria.…”

Section: Methodsmentioning

confidence: 99%

International multidisciplinary expert panel consensus on breast reconstruction and radiotherapy

Nava

Benson

Audretsch

et al. 2019

British Journal of Surgery

View full text Add to dashboard Cite

Background Conflicting evidence challenges clinical decision‐making when breast reconstruction is considered in the context of radiotherapy. Current literature was evaluated and key statements on topical issues were generated and discussed by an expert panel at the International Oncoplastic Breast Surgery Meeting in Milan 2017. Methods Studies on radiotherapy and breast reconstruction (1985 to September 2017) were screened using MEDLINE, Embase and CENTRAL. The literature review yielded 30 controversial key questions. A set of key statements was derived and the highest levels of clinical evidence (LoE) for each of these were summarized. Nineteen panellists convened for dedicated discussions at the International Oncoplastic Breast Surgery Meeting to express agreement, disagreement or abstention for the generated key statements. Results The literature review identified 1522 peer‐reviewed publications. A list of 22 key statements was produced, with the highest LoE recorded for each statement. These ranged from II to IV, with most statements (11 of 22, 50 per cent) supported by LoE III. There was full consensus for nine (41 per cent) of the 22 key statements, and more than 75 per cent agreement was reached for half (11 of 22). Conclusion Poor evidence exists on which to base patient‐informed consent. Low‐quality studies are conflicting with wide‐ranging treatment options, precluding expert consensus regarding optimal type and timing of breast reconstruction in the context of radiotherapy. There is a need for high‐quality evidence from prospective registries and randomized trials in this field.

show abstract

Porcine acellular dermis-based breast reconstruction: complications and outcomes following adjuvant radiotherapy

Cited by 16 publications

References 17 publications

Variation in the provision and practice of implant-based breast reconstruction in the UK: Results from the iBRA national practice questionnaire

Variation in the provision and practice of implant-based breast reconstruction in the UK: Results from the iBRA national practice questionnaire

Porcine acellular dermis-based breast reconstruction: complications and outcomes following adjuvant radiotherapy

International multidisciplinary expert panel consensus on breast reconstruction and radiotherapy

Contact Info

Product

Resources

About