Comparison of one-stage direct-to-implant with acellular dermal matrix and two-stage immediate implant-based breast reconstruction—a cohort study

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DOI

Background: The use of acellular dermal matrix (ADM) in one-stage immediate implant-based breast reconstruction (BR) may offer advantages over the two-stage expander-to-implant technique, but literature shows conflicting results. The aim of the present study was to compare these two techniques for immediate implant-based BR regarding postoperative complications, aesthetic correction procedures and aesthetic outcome. Methods! The study was designed as an observational cohort study with 44 participants admitted for immediate implant-based BR at Department of Plastic Surgery, Aarhus University Hospital, Denmark. 21 patients underwent BR with a one-stage direct-to-implant technique using ADM and 23 patients underwent BR with a two-stage expander-to-implant technique. Follow-up time was 2 years. Results! The risk of implant loss was equal between groups; one-stage group 16% and two-stage group 17% whereas the risk of implant exchange (but not loss of BR) was 13% in the one-stage group compared to 7% in the two-stage group. The risk of at least one major complication were equal between groups; 28% and 24% but the risk of at least one minor complication was significantly higher in the two-stage group (41%) compared to the one-stage group (3%). Number of aesthetic corrections were equally frequent in the two treatment groups (one-stage group 1.8, two-stage group 1.5). Patient and investigator assessed aesthetic outcome was very high in both groups as well as the degree of symmetry between breasts. No capsular contracture Baker grade 3 or 4 was observed. Conclusions! The present study design sets limitations for drawing wide conclusions. This study did not reveal any significant differences between the two breast reconstructive techniques besides a higher risk of minor complications in the two-stage group, that did, however, not lead to a higher risk of implant loss. With equally high satisfaction with the aesthetic result and no significant difference in number of aesthetic corrections between the two groups we suggest, that the one-stage approach using ADM may be feasible and allows the patient to achieve an implant-based BR with a minimum of surgeries and outpatient visits. The study was registered in ClinicalTrials.gov (NCT04209010).

OriginalsprogEngelsk
TidsskriftGland surgery
Vol/bind10
Nummer1
Sider (fra-til)207-218
Antal sider12
ISSN2227-684X
DOI
StatusUdgivet - jan. 2021

Bibliografisk note

Funding Information:
The authors wish to express their gratitude to the participating patients. Funding: This work was supported by the Danish Cancer Society [R130-A8304-15-S38]; the Korning foundation; Foundation of the Kjaersgaard Family, Sunds; King Christian X foundation; Foundation of Architect Holger Hjortenberg and LifeCell Corporation (Branchburg, NJ, USA). Furthermore, LifeCell Corporation LifeCell Corporation (Branchburg, NJ, USA) provided acellular dermal matrix (StratticeTM) for the study. None of the financial contributors had any involvement in the study design, data analysis or interpretation of the results.

Funding Information:
ICMJE uniform disclosure form (available at http:// dx.doi.org/10.21037/gs-20-581). MB reports grants from The Danish Cancer Society, grants from The Korning foundation, grants from Foundation of the Kjaersgaard Family, Sunds, grants from King Christian X foundation, grants from Foundation of Architect Holger Hjortenberg, grants and non-financial support from LifeCell Corporation (Branchburg, NJ, USA), during the conduct of the study. The other authors have no conflicts of interest to declare.

Funding Information:
The authors wish to express their gratitude to the participating patients. Funding: This work was supported by the Danish Cancer Society [R130-A8304-15-S38]; the Korning foundation; Foundation of the Kjaersgaard Family, Sunds; King Christian X foundation; Foundation of Architect Holger Hjortenberg and LifeCell Corporation (Branchburg, NJ, USA). Furthermore, LifeCell Corporation LifeCell Corporation (Branchburg, NJ, USA) provided acellular dermal matrix (Strattice?) for the study. None of the financial contributors had any involvement in the study design, data analysis or interpretation of the results.

Publisher Copyright:
© 2021. Gland Surgery. All rights reserved.

Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.

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