Response to: Gschwantler-Kaulich et al (2016) Mesh versus acellular dermal matrix in immediate implant-based breast reconstruction – A prospective randomized trial doi:10.1016/j.ejso.2016.02.007

Potter, Shelley; Holcombe, Chris; Blazeby, Jane M

doi:10.1016/j.ejso.2016.05.041

Cited by 5 publications

(4 citation statements)

References 8 publications

(6 reference statements)

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“…This is the first work comparing synthetic meshes vs. ADMs by a single surgeon, using the same surgical technique in a multicenter, retrospective analysis with this level of recruitment. Some limited (n=48) work is available to this extent, essentially favoring the cheaper mesh alternative (34)(35)(36). Since previous work by this group (8) has evaluated oncological interventions with two commonly used ADMs, we were now able to directly compare these synthetic mesh data to available ADM data in a total of 477 oncological and aesthetic interventions, making this the largest available body of data on this topic.…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Head-to-head Comparison Between TiLoop Bra/TiMesh® and Seragyn® in 320 Cases of Reconstructive Breast Surgery

et al. 2019

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Background/Aim: Clinical data concerning synthetic meshes in comparison to acellular dermal matrices (ADMs) in breast reconstruction are limited. Also, direct comparisons between titanium-coated polypropylene mesh and partially absorbable polypropylene mesh have not yet been reported. Materials and Methods: This analysis represents a retrospective, single-surgeon, multi-center study of 320 cases using either TiLoop Bra/TiMesh ® (n=192) or Seragyn ® (n=128) in breast reconstruction. Results were compared with ADM-based reconstructions (Epiflex ® and SurgiMend ® ). Results: Major complication rates (i.e. revision surgery) occurred in 3.9% (Seragyn ® ) and 8.3% (TiLoop Bra/TiMesh ® ) of all cases. Minor complications occurred in 18% (Seragyn ® ) and 8.9% (TiLoop Bra/TiMesh ® ). Subgroup analysis showed red breast syndrome to occur more often in the Seragyn group (3.9% Seragyn ® vs. 0.5% TiLoop Bra/TiMesh ® , p<0.05). Conclusion: TiLoop Bra/TiMesh ® and Seragyn ® do not differ significantly in complication rates. There was no difference in performance when compared to ADMs. Materials and MethodsThis work evaluated a multicenter, single surgeon experience over the course of 14 years with a total of 320 cases (Seragyn ® , n=128; TiLoop Bra/TiMesh ® , n=192) (Figure 1

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Section: Discussionmentioning

confidence: 99%

A Retrospective Head-to-head Comparison Between TiLoop Bra/TiMesh® and Seragyn® in 320 Cases of Reconstructive Breast Surgery

et al. 2019

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“…Future study designs will be informed by the iBRA data, but if this suggests equivalence between mesh-assisted techniques, an RCT comparing biological and synthetic products may be valuable given the significant cost differential (£1800 vs £200) between the products. A small Austrian RCT comparing TiLOOP and the ADM, Protexa, suggests that this design may be acceptable [19] , [20] , but as only 25% of units currently offer synthetic mesh-assisted procedures in the UK, more units would need to adopt the technique for such a trial to be feasible in this setting. Other potential study designs may include pre-pectoral vs subpectoral implant placement as products such as BRAXON are gaining in popularity and there may be benefits to a muscle-sparing approach [40] .…”

Section: Discussionmentioning

confidence: 99%

“…One North American trial compared two human ADMs [18] and demonstrated no difference between products and a second trial from Europe compared biological and synthetic meshes [19] . This latter study, although reported as a pilot-study, was in fact a small trial that was insufficiently well-designed to identify differences between the treatment groups [20] . To date, data from the UK comprise heterogeneous, often single-centre cohort studies or case-series [21] , [22] , much of which has been reported only in abstract form [23] , [24] .…”

Section: Introductionmentioning

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

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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.

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“…Patients in the acellular dermal matrix group also reported more postoperative pain, fatigue, and disruption to their family life than those in the synthetic mesh group. Although reported as a “pilot” trial, this study is a small trial that is insufficiently designed to look at the target difference between the treatment groups 19. No primary outcome or power calculation are reported and there are insufficient details to enable formal assessment of bias risk.…”

Section: What Is the Evidence Of Uncertainty?mentioning

confidence: 99%

Does the addition of mesh improve outcomes in implant based breast reconstruction after mastectomy for breast cancer?

Potter

MacKenzie

Blazeby

2018

BMJ

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Response to: Gschwantler-Kaulich et al (2016) Mesh versus acellular dermal matrix in immediate implant-based breast reconstruction – A prospective randomized trial doi:10.1016/j.ejso.2016.02.007

Cited by 5 publications

References 8 publications

A Retrospective Head-to-head Comparison Between TiLoop Bra/TiMesh® and Seragyn® in 320 Cases of Reconstructive Breast Surgery

A Retrospective Head-to-head Comparison Between TiLoop Bra/TiMesh® and Seragyn® in 320 Cases of Reconstructive Breast Surgery

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

Does the addition of mesh improve outcomes in implant based breast reconstruction after mastectomy for breast cancer?

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