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Implant-Based Immediate Breast Reconstruction: Pre-pectoral vs. Sub-pectoral—An Outcome Analysis. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02810-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Guo R, Li L, Su Y, Xiu B, Zhang Q, Wang J, Chi W, Yang B, Zhang Y, Cao A, Shao Z, Wu J. Current practice and barriers of mesh-assisted implant-based breast reconstruction in China: A nationwide cross-sectional survey of 110 hospitals. Eur J Surg Oncol 2019; 46:65-70. [PMID: 31519428 DOI: 10.1016/j.ejso.2019.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/04/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The current National Practice Questionnaire of implant-based breast reconstruction (IBBR) (NPQi) was to assess the clinical practice of mesh-assisted IBBR in China. METHODS A questionnaire was mailed to 110 hospitals in China, which have more than 200 breast cancer operations performed in 2017. The survey mainly included questions on the type and timing of IBBR, questions about the use of TiLOOP® Bra and acellular dermal matrix (ADM) and the complications of IBBR. RESULTS IBBR was routinely carried out in 86.36% (95/110) hospitals. IBBR was the most frequently-used (65.7%, 4,296/6,534) BR after mastectomy with a median of 24 cases (IQR 7.5-65) in each hospital. TiLOOP® Bra and ADM were available in 49.5% and 33.7% hospitals, respectively. Hospitals with ADM offered were more likely to located in economically developed regions (65.6%), when compared with hospitals without any mesh offered (14/35, 40.0%, P = 0.036) and with only TiLOOP® Bra offered (16/28, 57.1%, P = 0.032). The surgery volume was largely variated from hospitals without any mesh offered (median 380 cases, IQR 304-550), with only TiLOOP® Bra offered (median 790 cases, IQR 439-1096, P = 0.001) and with ADM offered (median 797 cases, IQR 497-1528, P < 0.001). Higher proportion of one-stage mesh-augmented direct-to-implant BR and lower proportion of autologous BR were observed in hospitals with mesh offered. The reported major complications were similar between hospitals with or without mesh offered. CONCLUSIONS The NPQi has provided a valuable insight into the current practice of IBBR and mesh used in China. The introduction of mesh-assisted techniques has revolutionized the clinical practice.
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Affiliation(s)
- Rong Guo
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, No. 270, Dongan Rd., Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, China
| | - Lun Li
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, No. 270, Dongan Rd., Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, China
| | - Yonghui Su
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, No. 270, Dongan Rd., Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, China
| | - Bingqiu Xiu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, No. 270, Dongan Rd., Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, China
| | - Qi Zhang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, No. 270, Dongan Rd., Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, China
| | - Jia Wang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, No. 270, Dongan Rd., Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, China
| | - Weiru Chi
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, No. 270, Dongan Rd., Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, China
| | - Benlong Yang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, No. 270, Dongan Rd., Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, China
| | - Yingying Zhang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, No. 270, Dongan Rd., Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, China
| | - Ayong Cao
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, No. 270, Dongan Rd., Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, China
| | - Zhimin Shao
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, No. 270, Dongan Rd., Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, China; Collaborative Innovation Center for Cancer Medicine, China
| | - Jiong Wu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, No. 270, Dongan Rd., Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, China; Collaborative Innovation Center for Cancer Medicine, China.
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Benson JR. One-stage direct-to-implant breast reconstruction using acellular dermal matrix. Lancet Oncol 2018; 19:1141-1143. [DOI: 10.1016/s1470-2045(18)30424-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 10/28/2022]
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Negenborn VL, Young-Afat DA, Dikmans REG, Smit JM, Winters HAH, Don Griot JPW, Twisk JWR, Ruhé PQ, Mureau MAM, Lapid O, Moerman E, van Turnhout AAWM, Ritt MJPF, Bouman MB, Mullender MG. Quality of life and patient satisfaction after one-stage implant-based breast reconstruction with an acellular dermal matrix versus two-stage breast reconstruction (BRIOS): primary outcome of a randomised, controlled trial. Lancet Oncol 2018; 19:1205-1214. [PMID: 30104147 DOI: 10.1016/s1470-2045(18)30378-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 05/13/2018] [Accepted: 05/15/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND There is increasing interest in the use of acellular dermal matrices (ADMs) in implant-based breast reconstruction (IBBR). Suggested advantages are that ADMs facilitate one-stage IBBR and improve aesthetic outcomes. We compared immediate one-stage ADM-assisted IBBR with two-stage IBBR (current standard of care). Our previously reported secondary endpoint showed that one-stage ADM-assisted IBBR was associated with significantly more adverse outcomes. Here, we present the primary endpoint results aiming to assess whether one-stage IBBR with ADM provides higher patient-reported quality of life (QOL) compared with two-stage IBBR. METHODS This multicentre, open-label, randomised controlled trial (BRIOS study) was done in eight hospitals in the Netherlands. We recruited women aged older than 18 years with breast carcinoma or a genetic predisposition who intended to undergo skin-sparing mastectomy and immediate IBBR. Participants were randomly assigned to undergo one-stage IBBR with ADM (Strattice, LifeCell, Branchburg, NJ, USA) or two-stage IBBR. Randomisation was stratified by centre and indication for surgery (oncological or prophylactic) in blocks of ten participants. The primary endpoint was patient-reported QOL, as measured with the BREAST-Q (ie, health-related QOL scales and satisfaction scales), in the modified intention-to-treat population. The study follow-up is complete. This study is registered with the Netherlands Trial Register, number NTR5446. FINDINGS Between April 14, 2013, and May 29, 2015, we enrolled 142 women, of whom 69 were randomly assigned to receive one-stage ADM-assisted IBBR and 73 to receive two-stage IBBR. After exclusions, the modified intention-to-treat population comprised 60 patients in the one-stage group and 61 patients in the two-stage group. Of these, 48 women (mean follow-up 17·0 months [SD 7·8]) in the one-stage group and 44 women (17·2 months [SD 6·7]) in the two-stage group completed the BREAST-Q at least 1 year after implant placement. We found no significant differences in postoperative patient-reported QOL domains, including physical wellbeing (one-stage mean 78·0 [SD 14·1] vs two-stage 79·3 [12·2], p=0·60), psychosocial wellbeing (72·6 [17·3] vs 72·8 [19·6], p=0·95), and sexual wellbeing (58·0 [17·0] vs 57·1 [19·5], p=0·82), or in the patient-reported satisfaction domains: satisfaction with breasts (63·4 [15·8] vs 60·3 [15·4], p=0·35) and satisfaction with outcome (72·8 [19·1] vs 67·8 [16·3], p=0·19). INTERPRETATION Taken together with our previously published findings, one-stage IBBR with ADM does not yield superior results in terms of patient-reported QOL compared with two-stage IBBR. Risks for adverse outcomes were significantly higher in the one-stage ADM group. Use of ADM for one-stage IBBM should be considered on a case-by-case basis. FUNDING Pink Ribbon, Nuts-Ohra, and LifeCell.
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Affiliation(s)
- Vera Lidwina Negenborn
- Department of Plastic, Reconstructive & Hand Surgery, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands; Research Institute, Amsterdam Public Health, Amsterdam, Netherlands
| | - Danny Aschwin Young-Afat
- Department of Plastic, Reconstructive & Hand Surgery, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands; Imaging Division, University Medical Center, Utrecht, Netherlands
| | - Rieky Elise Gustina Dikmans
- Department of Plastic, Reconstructive & Hand Surgery, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands; Research Institute, Amsterdam Public Health, Amsterdam, Netherlands
| | - Jan Maerten Smit
- Department of Plastic, Reconstructive & Hand Surgery, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands; Alexander Monro Breast Cancer Hospital, Bilthoven, Netherlands
| | - Henri Adolf Hubert Winters
- Department of Plastic, Reconstructive & Hand Surgery, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands; Alexander Monro Breast Cancer Hospital, Bilthoven, Netherlands
| | | | | | - Pieter Quinten Ruhé
- Department of Plastic, Reconstructive & Hand Surgery, Meander Medical Centre, Amersfoort, Netherlands
| | - Marcus Antonius Maria Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Oren Lapid
- Department of Plastic, Reconstructive & Hand Surgery, Amsterdam UMC Academic Medical Center, University of Amsterdam, Netherlands
| | - Esther Moerman
- Department of Plastic, Reconstructive & Hand Surgery, Amsterdam UMC Academic Medical Center, University of Amsterdam, Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Onze Lieve Vrouwe Gasthuis Oost, Amsterdam, Netherlands
| | | | | | - Mark-Bram Bouman
- Department of Plastic, Reconstructive & Hand Surgery, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands; Alexander Monro Breast Cancer Hospital, Bilthoven, Netherlands
| | - Margriet Gezina Mullender
- Department of Plastic, Reconstructive & Hand Surgery, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands; Research Institute, Amsterdam Public Health, Amsterdam, Netherlands.
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Mylvaganam S, Conroy E, Williamson PR, Barnes NLP, Cutress RI, Gardiner MD, Jain A, Skillman JM, Thrush S, Whisker LJ, Blazeby JM, Potter S, Holcombe C. Variation in the provision and practice of implant-based breast reconstruction in the UK: Results from the iBRA national practice questionnaire. Breast 2017; 35:182-190. [PMID: 28768227 PMCID: PMC5590633 DOI: 10.1016/j.breast.2017.07.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 07/19/2017] [Accepted: 07/24/2017] [Indexed: 11/30/2022] Open
Abstract
Introduction The introduction of biological and synthetic meshes has revolutionised the practice of implant-based breast reconstruction (IBBR) but evidence for effectiveness is lacking. The iBRA (implant Breast Reconstruction evAluation) study is a national trainee-led project that aims to explore the practice and outcomes of IBBR to inform the design of a future trial. We report the results of the iBRA National Practice Questionnaire (NPQ) which aimed to comprehensively describe the provision and practice of IBBR across the UK. Methods A questionnaire investigating local practice and service provision of IBBR developed by the iBRA Steering Group was completed by trainee and consultant leads at breast and plastic surgical units across the UK. Summary data for each survey item were calculated and variation between centres and overall provision of care examined. Results 81 units within 79 NHS-hospitals completed the questionnaire. Units offered a range of reconstructive techniques, with IBBR accounting for 70% (IQR:50–80%) of participating units' immediate procedures. Units on average were staffed by 2.5 breast surgeons (IQR:2.0–3.0) and 2.0 plastic surgeons (IQR:1.0–3.0) performing 35 IBBR cases per year (IQR:20-50). Variation was demonstrated in the provision of novel different techniques for IBBR especially the use of biological (n = 62) and synthetic (n = 25) meshes and in patient selection for these procedures. Conclusions The iBRA-NPQ has demonstrated marked variation in the provision and practice of IBBR in the UK. The prospective audit phase of the iBRA study will determine the safety and effectiveness of different approaches to IBBR and allow evidence-based best practice to be explored. Implant breast reconstruction (IBBR) and the range of techniques is poorly evidence based. We aimed to explore the current practice of IBBR in the UK to inform the design of a future definitive study. Significant variation was demonstrated in the availability of techniques and patient selection for IBBR. There is a need for well-designed studies to establish best practice and improve outcomes for patients considering IBBR.
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Affiliation(s)
- Senthurun Mylvaganam
- New Cross Hospital, Royal Wolverhampton Hospitals NHS Trust, Wednesfield Way, Wolverhampton, WV10 0QP, UK
| | - Elizabeth Conroy
- Clinical Trials Research Centre (CTRC), North West Hub for Trials Methodology/University of Liverpool, Liverpool, L12 2AP, UK
| | - Paula R Williamson
- Clinical Trials Research Centre (CTRC), North West Hub for Trials Methodology/University of Liverpool, Liverpool, L12 2AP, UK
| | - Nicola L P Barnes
- Breast Unit, University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK
| | - Ramsey I Cutress
- Breast Unit, University Hospital Southampton, Tremona Road, Southampton, Hampshire, SO16 6YD, UK; Faculty of Medicine, Cancer Sciences Unit, University of Southampton, Somers Cancer Research Building, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Matthew D Gardiner
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7HE, UK; Department of Plastic Surgery, Imperial College London NHS Trust, London, SW7 2AZ, UK
| | - Abhilash Jain
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7HE, UK; Department of Plastic Surgery, Imperial College London NHS Trust, London, SW7 2AZ, UK
| | - Joanna M Skillman
- Department of Plastic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Steven Thrush
- Breast Unit, Worcester Royal Hospital, Charles Hastings Way, Worcester, WR5 1DD, UK
| | - Lisa J Whisker
- Breast Institute, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham, NG5 1PB, UK
| | - Jane M Blazeby
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Clifton, Bristol, BS8 2PS, UK
| | - Shelley Potter
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Clifton, Bristol, BS8 2PS, UK; Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital, Prescot Street, Liverpool, L7 8XP, UK.
| | - Christopher Holcombe
- Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital, Prescot Street, Liverpool, L7 8XP, UK
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