Outcome of 602 cases of sling-assisted implant-based breast reconstruction
Association of Breast Surgery ePoster Library. Barber M. 05/15/17; 166174; P013
Mr. Matthew Barber
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Abstract
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Introduction
The use of extrinsic slings to assist implant-based breast reconstruction offers the possibility of a one-stage procedure and may have cosmetic benefits, however, concerns remain over outcome.
Methods
All cases where an extrinsic sling was used in a breast reconstructive procedure in Edinburgh from initial use on 7/7/2008 to 30/6/2016 were reviewed.
Results
602 sheets of sling material (220 Strattice, 213 Veritas, 76 TiLoop, 72 Permacol and 20 with 4 other materials) were used in 576 breasts of 383 patients. 103 reconstructions were lost (17.1%). Loss rate was 9.0% at 3 months and 12.6% at 6 months. 18 of 94 patients (19.1%) requiring adjuvant therapy had this delayed due to complications. 69 of 203 patients (34%) having unilateral surgery have undergone contralateral symmetrisation. Patients underwent a mean of 1.4 further operations (0-9) on the affected breast. Implant loss varied significantly with smoking (33% loss in smokers vs 11.3% in non-smokers, p<0.0001) and with use of radiotherapy (25.9% loss with radiotherapy vs 14.2% without, p=0.0037). There was no significant variation with operating surgeon, type of sling used, breast weight, patient weight, nipple preservation or chemotherapy use. Long term loss rate in non-smokers who did not receive radiotherapy was 9.6%. There was limited evidence of an improvement in results over time.
Conclusions
While offering potential cosmetic and financial benefits, sling-assisted implant breast reconstruction has a significant rate of reconstruction loss, need for further surgery and delay in adjuvant therapy. These should be important considerations for patient selection and consent.
The use of extrinsic slings to assist implant-based breast reconstruction offers the possibility of a one-stage procedure and may have cosmetic benefits, however, concerns remain over outcome.
Methods
All cases where an extrinsic sling was used in a breast reconstructive procedure in Edinburgh from initial use on 7/7/2008 to 30/6/2016 were reviewed.
Results
602 sheets of sling material (220 Strattice, 213 Veritas, 76 TiLoop, 72 Permacol and 20 with 4 other materials) were used in 576 breasts of 383 patients. 103 reconstructions were lost (17.1%). Loss rate was 9.0% at 3 months and 12.6% at 6 months. 18 of 94 patients (19.1%) requiring adjuvant therapy had this delayed due to complications. 69 of 203 patients (34%) having unilateral surgery have undergone contralateral symmetrisation. Patients underwent a mean of 1.4 further operations (0-9) on the affected breast. Implant loss varied significantly with smoking (33% loss in smokers vs 11.3% in non-smokers, p<0.0001) and with use of radiotherapy (25.9% loss with radiotherapy vs 14.2% without, p=0.0037). There was no significant variation with operating surgeon, type of sling used, breast weight, patient weight, nipple preservation or chemotherapy use. Long term loss rate in non-smokers who did not receive radiotherapy was 9.6%. There was limited evidence of an improvement in results over time.
Conclusions
While offering potential cosmetic and financial benefits, sling-assisted implant breast reconstruction has a significant rate of reconstruction loss, need for further surgery and delay in adjuvant therapy. These should be important considerations for patient selection and consent.
Introduction
The use of extrinsic slings to assist implant-based breast reconstruction offers the possibility of a one-stage procedure and may have cosmetic benefits, however, concerns remain over outcome.
Methods
All cases where an extrinsic sling was used in a breast reconstructive procedure in Edinburgh from initial use on 7/7/2008 to 30/6/2016 were reviewed.
Results
602 sheets of sling material (220 Strattice, 213 Veritas, 76 TiLoop, 72 Permacol and 20 with 4 other materials) were used in 576 breasts of 383 patients. 103 reconstructions were lost (17.1%). Loss rate was 9.0% at 3 months and 12.6% at 6 months. 18 of 94 patients (19.1%) requiring adjuvant therapy had this delayed due to complications. 69 of 203 patients (34%) having unilateral surgery have undergone contralateral symmetrisation. Patients underwent a mean of 1.4 further operations (0-9) on the affected breast. Implant loss varied significantly with smoking (33% loss in smokers vs 11.3% in non-smokers, p<0.0001) and with use of radiotherapy (25.9% loss with radiotherapy vs 14.2% without, p=0.0037). There was no significant variation with operating surgeon, type of sling used, breast weight, patient weight, nipple preservation or chemotherapy use. Long term loss rate in non-smokers who did not receive radiotherapy was 9.6%. There was limited evidence of an improvement in results over time.
Conclusions
While offering potential cosmetic and financial benefits, sling-assisted implant breast reconstruction has a significant rate of reconstruction loss, need for further surgery and delay in adjuvant therapy. These should be important considerations for patient selection and consent.
The use of extrinsic slings to assist implant-based breast reconstruction offers the possibility of a one-stage procedure and may have cosmetic benefits, however, concerns remain over outcome.
Methods
All cases where an extrinsic sling was used in a breast reconstructive procedure in Edinburgh from initial use on 7/7/2008 to 30/6/2016 were reviewed.
Results
602 sheets of sling material (220 Strattice, 213 Veritas, 76 TiLoop, 72 Permacol and 20 with 4 other materials) were used in 576 breasts of 383 patients. 103 reconstructions were lost (17.1%). Loss rate was 9.0% at 3 months and 12.6% at 6 months. 18 of 94 patients (19.1%) requiring adjuvant therapy had this delayed due to complications. 69 of 203 patients (34%) having unilateral surgery have undergone contralateral symmetrisation. Patients underwent a mean of 1.4 further operations (0-9) on the affected breast. Implant loss varied significantly with smoking (33% loss in smokers vs 11.3% in non-smokers, p<0.0001) and with use of radiotherapy (25.9% loss with radiotherapy vs 14.2% without, p=0.0037). There was no significant variation with operating surgeon, type of sling used, breast weight, patient weight, nipple preservation or chemotherapy use. Long term loss rate in non-smokers who did not receive radiotherapy was 9.6%. There was limited evidence of an improvement in results over time.
Conclusions
While offering potential cosmetic and financial benefits, sling-assisted implant breast reconstruction has a significant rate of reconstruction loss, need for further surgery and delay in adjuvant therapy. These should be important considerations for patient selection and consent.
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