Abstract P5-16-05: Prepectoral immediate implant-based reconstruction using Braxon® acellular dermal matrix – National audit from the United Kingdom
Authors: Chandarana M , Harries S 
Published: May 2019

Background

Implant based reconstruction is the most common method of reconstruction in the United Kingdom (UK) for women having a mastectomy for breast cancer or as a risk reducing procedure. Prepectoral reconstruction with full implant coverage using an acellular dermal matrix (ADM) – BRAXON - is a relatively new technique. Prepectoral reconstruction has the advantages of a better aesthetic outcome, less postoperative pain, quicker return to normal activities and no postoperative problems with animation. We report on the outcomes of prepectoral immediate breast reconstruction (IBR) using Braxon®ADM from a National audit.

Methods

A retrospective multi-centre audit of all direct-to-implant reconstructions using Braxon®in the United Kingdom was carried out . The demographic details, treatment details, short-term and long-term outcomes were evaluated. Factors affecting complication rates were analysed.

Results

Data from 406 Braxon reconstructions in 324 patients across 20 centres in the UK were collated. Mean age of the cohort was 50.48 (SD – 11.11, range – 20-82) years with a mean BMI of 26.05 (SD – 4.87, range – 18-42) kg/m2. Demographic and treatment characteristics are given in Table 1. The mean follow-up period was 10.94 months (0.3 to 34.8 months). The overall complication rate was 32% with a readmission rate of 16% and an implant loss rate of 9%. Of the factors evaluated for their effect on complication rates, patient age (p = 0.005), therapeutic mastectomy (p = 0.001), specimen weight (p &lt; 0.005) and axillary nodal clearance (p = 0.006) were significantly associated with higher complication rate on univariate analysis.

Patient demographics and treatment detailsCharacteristicNumber (Percentage)Number of patients324Number of reconstructions406Mean Age (years)50.48Mean Body Mass Index (kg/m2)26.05Smoker / Ex-smoker30Indication for surgery Therapeutic mastectomy241 (74.3)Prophylactic mastectomy83 (25.6)Neo-adjuvant chemotherapy55 (16.9)Previous radiation therapy17 (5.24)Adjuvant radiation therapy55 (16.9)Adjuvant chemotherapy55 (16.9)Type of mastectomy Skin-sparing mastectomy143 (44.13)Nipple-sparing mastectomy143 (44.13)Skin-reducing mastectomy37 (11.41)Management of axilla Sentinel node biopsy207 (63.8)Axillary nodal clearance54 (16.6)No axillary surgery63 (19.4)Mean specimen weight (grams)433.24Mean implant volume (cc)374.5Complications105 (32)Implant loss36/406 (8.87)

Conclusion

Implant-based prepectoral breast reconstruction with Braxon®has satisfactory short-term and long-term operative outcomes, comparable to the National Mastectomy Audit data from the United Kingdom. Patient-reported outcomes, aesthetic outcomes and post operative pain need to be evaluated. Further studies with larger numbers of patients and longer follow-up have been planned.

Citation Format: Chandarana M, Harries S. Prepectoral immediate implant-based reconstruction using Braxon® acellular dermal matrix – National audit from the United Kingdom [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 P5-16-05.