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Development of an evidence-based approach to the use of acellular dermal matrix in immediate expander-implant-based breast reconstruction
- Source :
- Journal of Plastic, Reconstructive & Aesthetic Surgery. 74:30-40
- Publication Year :
- 2021
- Publisher :
- Elsevier BV, 2021.
-
Abstract
- Summary Background Although acellular dermal matrix (ADM) is widely used in expander-implant-based breast reconstructions, previous analyses have been unable to demonstrate improvements in patient-reported outcomes (PROs) with this approach over non-ADM procedures. This study aims to develop a more selective, evidence-based approach to the use of ADM in expander-implant-based breast reconstruction by identifying patient subgroups in which ADM improved clinical outcomes and PROs. Study design The Mastectomy Reconstruction Outcomes Consortium Study prospectively evaluated immediate expander-implant reconstructions at 11 centers from 2012 to 2015. Complications (any/overall and major), and PROs (satisfaction, physical, psychosocial, and sexual well-being) were assessed two years postoperatively using medical records and the BREAST-Q, respectively. Using mixed-models accounting for centers and with interaction terms, we analyzed for differential ADM effects across various clinical subgroups, including age, body mass index, radiation timing, and chemotherapy. Results Expander-implant-based breast reconstruction was performed in 1451 patients, 738 with and 713 without ADM. Major complication risk was higher in ADM users vs. nonusers (22.9% vs. 16.4% and p = 0.04). Major complication risk with ADM increased with higher BMI (BMI=30, OR=1.70; BMI=35, OR=2.29, interaction p = 0.02). No significant ADM effects were observed for breast satisfaction, psychosocial, sexual, and physical well-being within any subgroups. Conclusion In immediate expander-implant-based breast reconstruction, ADM was associated with a greater risk of major complications, particularly in high-BMI patients. We were unable to identify patient subgroups where ADM was associated with significant improvements in PROs. Given these findings and the financial costs of ADM, a more critical approach to the use of ADM in expander-implant reconstruction may be warranted.
- Subjects :
- Adult
Oncology
medicine.medical_specialty
Time Factors
Evidence-based practice
Breast Implants
medicine.medical_treatment
Tissue Expansion
Breast Neoplasms
030230 surgery
Body Mass Index
03 medical and health sciences
0302 clinical medicine
Internal medicine
Surgical Wound Dehiscence
medicine
Humans
Surgical Wound Infection
Acellular Dermis
Patient Reported Outcome Measures
Prospective Studies
Breast Implantation
Mastectomy
Evidence-Based Medicine
business.industry
Medical record
Middle Aged
Surgery
030220 oncology & carcinogenesis
Female
Implant
business
Breast reconstruction
Dermal matrix
Psychosocial
Body mass index
Subjects
Details
- ISSN :
- 17486815
- Volume :
- 74
- Database :
- OpenAIRE
- Journal :
- Journal of Plastic, Reconstructive & Aesthetic Surgery
- Accession number :
- edsair.doi.dedup.....641906f4698be0cee0afecca7facc1a2