Acellular dermal matrix assisted subpectoral versus prepectoral implant placement; comparing pain and patient reported outcomes.
Association of Breast Surgery ePoster Library. Baker B. 05/15/17; 166308; P024
Mr. Benjamin Baker
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Abstract
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Background/Aims
Pre-pectoral implant based acellular dermal matrix (ADM) assisted immediate breast reconstruction (IBR) is gaining popularity, including complete implant coverage with ADM. Perceived benefits are a reduction in postoperative pain and breast animation deformity, with preservation of upper limb mobility. We aimed to compare pain, patient reported outcome measures (PROMs), length of stay (LoS), and safety of prepectoral versus subpectoral Strattice™ assisted IBR.
Methods
Consecutive patients were recruited prospectively, having either cancer resection or prophylactic mastectomy. There were no exclusion criteria. Patients scored pain contemporaneously three times per day for the first seven post-operative days on a likert scale, and completed the BREAST-Q™ reconstruction module three months post-operatively.
Results
38 patients were recruited. There was no significant difference in pain scores between groups (prepectoral n=21, mean 1.45 vs subpectoral 10, 1.51; p=0.45) during the first seven days. 31 BREAST-Qs™ were returned; Q scores were similar for prepectoral (mean 76) and subpectoral (mean 79) groups, but patients reported significantly more visible implant rippling in the prepectoral versus subpectoral group (7/13 vs 2/17, p=0.02). There was no significant difference in LoS (prepectoral 2.1 days vs subpectoral 2.3; p=0.44) or safety profile. 1 patient required re-operation for implant removal secondary to infection in the prepectoral group.
Conclusions
This is the first study to compare pain and PROMs in prepectoral breast reconstruction with subpectoral; these were equivalent between groups. Prepectoral implant placement with complete ADM cover is safe. Prepectoral reconstruction is feasible but further studies are required to compare short and long term outcomes.
Pre-pectoral implant based acellular dermal matrix (ADM) assisted immediate breast reconstruction (IBR) is gaining popularity, including complete implant coverage with ADM. Perceived benefits are a reduction in postoperative pain and breast animation deformity, with preservation of upper limb mobility. We aimed to compare pain, patient reported outcome measures (PROMs), length of stay (LoS), and safety of prepectoral versus subpectoral Strattice™ assisted IBR.
Methods
Consecutive patients were recruited prospectively, having either cancer resection or prophylactic mastectomy. There were no exclusion criteria. Patients scored pain contemporaneously three times per day for the first seven post-operative days on a likert scale, and completed the BREAST-Q™ reconstruction module three months post-operatively.
Results
38 patients were recruited. There was no significant difference in pain scores between groups (prepectoral n=21, mean 1.45 vs subpectoral 10, 1.51; p=0.45) during the first seven days. 31 BREAST-Qs™ were returned; Q scores were similar for prepectoral (mean 76) and subpectoral (mean 79) groups, but patients reported significantly more visible implant rippling in the prepectoral versus subpectoral group (7/13 vs 2/17, p=0.02). There was no significant difference in LoS (prepectoral 2.1 days vs subpectoral 2.3; p=0.44) or safety profile. 1 patient required re-operation for implant removal secondary to infection in the prepectoral group.
Conclusions
This is the first study to compare pain and PROMs in prepectoral breast reconstruction with subpectoral; these were equivalent between groups. Prepectoral implant placement with complete ADM cover is safe. Prepectoral reconstruction is feasible but further studies are required to compare short and long term outcomes.
Background/Aims
Pre-pectoral implant based acellular dermal matrix (ADM) assisted immediate breast reconstruction (IBR) is gaining popularity, including complete implant coverage with ADM. Perceived benefits are a reduction in postoperative pain and breast animation deformity, with preservation of upper limb mobility. We aimed to compare pain, patient reported outcome measures (PROMs), length of stay (LoS), and safety of prepectoral versus subpectoral Strattice™ assisted IBR.
Methods
Consecutive patients were recruited prospectively, having either cancer resection or prophylactic mastectomy. There were no exclusion criteria. Patients scored pain contemporaneously three times per day for the first seven post-operative days on a likert scale, and completed the BREAST-Q™ reconstruction module three months post-operatively.
Results
38 patients were recruited. There was no significant difference in pain scores between groups (prepectoral n=21, mean 1.45 vs subpectoral 10, 1.51; p=0.45) during the first seven days. 31 BREAST-Qs™ were returned; Q scores were similar for prepectoral (mean 76) and subpectoral (mean 79) groups, but patients reported significantly more visible implant rippling in the prepectoral versus subpectoral group (7/13 vs 2/17, p=0.02). There was no significant difference in LoS (prepectoral 2.1 days vs subpectoral 2.3; p=0.44) or safety profile. 1 patient required re-operation for implant removal secondary to infection in the prepectoral group.
Conclusions
This is the first study to compare pain and PROMs in prepectoral breast reconstruction with subpectoral; these were equivalent between groups. Prepectoral implant placement with complete ADM cover is safe. Prepectoral reconstruction is feasible but further studies are required to compare short and long term outcomes.
Pre-pectoral implant based acellular dermal matrix (ADM) assisted immediate breast reconstruction (IBR) is gaining popularity, including complete implant coverage with ADM. Perceived benefits are a reduction in postoperative pain and breast animation deformity, with preservation of upper limb mobility. We aimed to compare pain, patient reported outcome measures (PROMs), length of stay (LoS), and safety of prepectoral versus subpectoral Strattice™ assisted IBR.
Methods
Consecutive patients were recruited prospectively, having either cancer resection or prophylactic mastectomy. There were no exclusion criteria. Patients scored pain contemporaneously three times per day for the first seven post-operative days on a likert scale, and completed the BREAST-Q™ reconstruction module three months post-operatively.
Results
38 patients were recruited. There was no significant difference in pain scores between groups (prepectoral n=21, mean 1.45 vs subpectoral 10, 1.51; p=0.45) during the first seven days. 31 BREAST-Qs™ were returned; Q scores were similar for prepectoral (mean 76) and subpectoral (mean 79) groups, but patients reported significantly more visible implant rippling in the prepectoral versus subpectoral group (7/13 vs 2/17, p=0.02). There was no significant difference in LoS (prepectoral 2.1 days vs subpectoral 2.3; p=0.44) or safety profile. 1 patient required re-operation for implant removal secondary to infection in the prepectoral group.
Conclusions
This is the first study to compare pain and PROMs in prepectoral breast reconstruction with subpectoral; these were equivalent between groups. Prepectoral implant placement with complete ADM cover is safe. Prepectoral reconstruction is feasible but further studies are required to compare short and long term outcomes.
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