Resource utilization and patient reported outcomes using acellular dermal matrix in breast reconstructive procedures

Background: The introduction of acellular dermal matrices revolutionized implant-based breast reconstructive procedures. Literature reports both advantages and disadvantages associated to the use of acellular dermal matrix (ADM). The increasing number of breast reconstructive procedures being performed leads to an awareness of improving the psychosocial and functional result and reduce costs associated with these procedures. One-stage implant-based breast reconstruction (BR) with ADM has potential advantages for the patient, but literature shows conflicting results regarding the cost-effectiveness of this approach compared to the two-stage expander-to-implant method. The patient’s subjective assessment of the physical and psychosocial effects of BR is extremely important. To contribute to knowledge on the subject, we present a study where the aim was to compare immediate implant-based BR using the ADM assisted one-stage approach with the two-stage expander-to-implant approach regarding resource utilization and patient reported outcomes (PROs). 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, Aarhus, Denmark. BR was performed with a one-stage technique in 21 patients and with a two-stage technique in 23 patients. Follow-up time was 2 years. Results: Overall, in favor of the one-stage group was a shorter duration of surgery and furthermore, the reduced need for outpatient visits (for expansions) as well as for additional surgery for implant exchange. In favor of the two-stage approach was reduced cost of materials and fewer interventions to address the aesthetic outcome. Pain, sensory disturbances, physical limitations, health status, quality of life (QoL) and body image were equally favorable between the two groups at 2-year follow-up. Conclusions: This study does not provide clear evidence for an advantageous use of resources by one method versus the other and further studies should be undertaken to investigate the cost-effectiveness. Considering the equally good results in the two treatment groups regarding PROs the one-stage approach may be preferred if the patient is deemed suitable and is well informed of the potential need for additional interventions to obtain an aesthetically satisfying result.