Establishing an equipoise: Does the use of acellular dermal matrices in pre-pectoral implant-based breast reconstruction improve outcomes?

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery Pub Date : 2024-09-17 DOI:10.1016/j.bjps.2024.09.041

Hannah Cook , David Zargaran , Sevasti Panagiota Glynou , Alexander Zargaran , Mo Akhavani , Norman Williams , Stephen Hamilton , Afshin Mosahebi

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引用次数: 0

Abstract

Introduction

Breast cancer is the most common malignancy among women in the United Kingdom. Surgical management commonly comprises mastectomy and reconstruction, of which implant-based breast reconstruction (IBBR) is the most prevalent. Acellular dermal matrices (ADM) are widely used in pre-pectoral IBBR; however, there is limited high-quality evidence supporting their efficacy. This study aimed to establish an equipoise via an expert consensus survey.

Methods

An online survey was designed with a steering group of experts. Questions covered participant information, opinions regarding surgical outcomes with ADM use in pre-pectoral IBBR and opinions regarding the available scientific evidence on the topic. The survey was advertised via national and international professional organisations. Quantitative and qualitative analyses were performed.

Results

Thirty-two participants from the UK, Italy and Australia completed the survey. Key findings of this study included disagreement among participants regarding the surgical outcomes associated with ADM use. Participants who believed that ADM reduced the risk of short-term complications and implant failure/explantation comprised a minority (21.9%). Participants who felt that ADM use improved cosmetic outcomes and reduced long-term complications were a relative majority at 43.8% and 40.6%, respectively. Furthermore, 56.3% of the participants felt that there was scarce scientific evidence on the topic.

Conclusions

This study provides insights from international surgeons, establishing a lack of consensus on surgical outcomes, efficacy and evidence-base supporting the use of ADMs in pre-pectoral IBBR. Given this clinical equipoise, alongside the growing burden of breast cancer associated morbidity and need for reconstruction, the implications of this study are that large-scale, prospective, randomised-controlled data are needed to establish whether ADM use in pre-pectoral breast reconstruction improves the outcomes.

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建立平衡：在胸大肌前植入假体的乳房重建中使用非细胞真皮基质是否能改善效果？

导言乳腺癌是英国妇女最常见的恶性肿瘤。手术治疗通常包括乳房切除和重建，其中植入物乳房重建（IBBR）最为普遍。细胞真皮基质（ADM）被广泛应用于胸大肌前乳房重建，但支持其疗效的高质量证据却很有限。本研究旨在通过专家共识调查建立一种平衡。问题包括参与者信息、对口腔前 IBBR 使用 ADM 的手术效果的看法以及对该主题现有科学证据的看法。调查通过国内和国际专业组织进行宣传。来自英国、意大利和澳大利亚的 32 名参与者完成了调查。本研究的主要发现包括：参与者对使用 ADM 所带来的手术效果存在分歧。认为 ADM 可降低短期并发症和种植失败/移植风险的参与者占少数（21.9%）。认为使用 ADM 可改善外观效果和减少长期并发症的参与者相对占多数，分别为 43.8% 和 40.6%。此外，56.3% 的参与者认为有关该主题的科学证据很少。结论这项研究提供了来自国际外科医生的见解，确定了在手术结果、疗效和证据基础方面缺乏支持在胸前 IBBR 中使用 ADM 的共识。鉴于这种临床上的不一致，以及乳腺癌相关发病率和重建需求的不断增长，本研究的意义在于需要大规模、前瞻性、随机对照数据来确定在胸大肌前乳房重建中使用 ADM 是否能改善手术效果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Plastic Reconstructive and Aesthetic Surgery 医学-外科

CiteScore

3.10

自引率

11.10%

发文量

578

审稿时长

3.5 months

期刊介绍： JPRAS An International Journal of Surgical Reconstruction is one of the world''s leading international journals, covering all the reconstructive and aesthetic aspects of plastic surgery. The journal presents the latest surgical procedures with audit and outcome studies of new and established techniques in plastic surgery including: cleft lip and palate and other heads and neck surgery, hand surgery, lower limb trauma, burns, skin cancer, breast surgery and aesthetic surgery.