Abstract P5-16-03: The long-term outcomes of the BROWSE multicentre cohort study comparing Strattice™-assisted implant based reconstruction and submuscular reconstruction
Authors: Wilson RL , Kirwan CC , O'Donoghue JM , Linforth RA , Johnson RK , Harvey JR 
Published: May 2019

Introduction

Implant based reconstruction accounts for approximately 85% of reconstructions in the UK and 80% in the US with an increase in use of acellular dermal matrices (ADM) e.g. Strattice™. There is little long-term data on the outcomes of ADM reconstructions and its efficacy. Our aim was to establish the most comprehensive long-term surgical, cost-effectiveness, quality of life and cosmetic outcomes in three large UK reconstructive centres.

Methods

All women who had undergone immediate implant based breast reconstruction with Strattice™ or a submuscular technique between 2009 and 2015 across three tertiary centres in the UK were invited for prospective clinical (examination and tonometry), cosmetic and quality of life assessment. An eight year retrospective review of case notes, theatre database and implant log was performed.

Results

601 patients underwent 837 reconstructions. 589 Strattice™-assisted (331 therapeutic, 258 risk reduction) and 248 submuscular (152 therapeutic, 96 risk reduction).

Revision surgery was performed in 43% of Strattice™-assisted reconstructions and 35% of submuscular within the follow-up period (p=0.034). Strattice™-assisted reconstructions were revised significantly sooner than submuscular, median time to first revision of 12 months vs. 21 months (p&lt;0.0001).There was a significant reduction in the need for revision surgery for capsular contracture in the Strattice™-assisted group (Strattice™ n=19, submuscular n=16, p=0.04). Revision rates for capsular contracture in those having prior or adjuvant radiotherapy were 33% (n=9) in the Strattice™-assisted group and 66% (n=2) in the submuscular.

At a median time of 58 months from initial procedure, 10% in the Strattice™-assisted group and 14% in the submuscular had significant capsular contracture (Baker 3/4). At the time of assessment 7% of the Strattice™-assisted group and 17% of the submuscular had already undergone revision surgery for capsular contracture. Therefore, overall there was significantly more capsular contracture in the submuscular group (17% vs. 31%, p=0.047). There was no difference between the mean (of the four quadrant readings) breast tonometry reading between the two groups (0 hard – 10 soft). The median reading was 5.3 in the Strattice™-assisted group, 5.4 in the submuscular and 6.6 in native breasts. Those with Baker 1/2 had a median reading of 5.4 compared to 4.8 in those with a Baker 3/4 capsule.

Quality of life was equivalent between the two groups at a median time of 58 months. There was no difference in median Breast Q score for satisfaction with breasts, Strattice™-assisted 62 vs. submuscular 58 or satisfaction with outcome 67 vs. 75.

The mean cost of the index reconstructive procedure was less in the Strattice™-assisted group (£3634 vs. £4230) but there were no significant differences in long-term cost.

Conclusion

Long-term clinical outcomes support the use of Strattice™ in breast reconstruction. It reduces capsular contracture and enables patients to have their surgery in one rather than two procedures. The increased revision rate in the Strattice-assisted group was multi-faceted e.g. patient request to upsize and correction of contouring defects. Strattice™ reduces healthcare cost.

Citation Format: Wilson RL, Kirwan CC, O'Donoghue JM, Linforth RA, Johnson RK, Harvey JR. The long-term outcomes of the BROWSE multicentre cohort study comparing Strattice™-assisted implant based reconstruction and submuscular reconstruction [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-16-03.