Abstract PS1-09: Long-term results of prepectoral implant-based reconstruction using braxon®acellular dermal matrix - national audit from United Kingdom
Authors: Chandarana Mihir , Narayanan Sankaran , Parmeshwar Rishikesh 
Published: February 2021

Abstract
BackgroundSingle stage direct-to-implant reconstruction is the most common method of reconstruction in the United Kingdom (UK) after a mastectomy. Prepectoral implant placement with full implant coverage using acellular dermal matrix (ADM) is a relatively new technique with paucity of data on surgical outcomes. We report on long term outcomes of prepectoral breast reconstruction (PBR) using Braxon® ADM from a multicentre audit across the UKMethodsA retrospective multicentre audit of all direct-to-implant post-mastectomy PBR using Braxon® was conducted. The demographic details, treatment details, 90-day complication rates and implant loss rates for the entire study period were evaluated. Factors affecting major complication rates and implant loss rates were analysed using univariable and multivariable analysis.ResultsEight hundred and twenty two patients underwent 1020 post-mastectomy PBR across 29 centres in the UK from January 2014 to 2019. Median age of the cohort was 49 years with a median BMI of 25 kg/m2. The median and mean follow-up periods were 14 and 17.54 months respectively. The overall 90-day complication rate was 26.47% with major complications in 13.04% of patients. The 90-day readmission rate was 11.18% and return to theatre rate was 12.25%, with a 90-day implant loss rate of 5.1 percent. The implant loss rate was 6.28% for the entire study period. On multivariable analysis, therapeutic mastectomy (p = 0.008) and a higher breast specimen weight (p = 0.000) were the only factors to significantly impact major complications. Implant loss rates were significantly higher in current smokers (p = 0.000) and patients with previous breast radiation therapy (p = 0.010), axillary nodal clearance (p = 0.007), high breast specimen weight (p = 0.034) and a higher implant volume (p = 0.044) on multivariable analysis.ConclusionImplant-based prepectoral breast reconstruction with Braxon® acellular dermal matrix has satisfactory short-term and long-term operative outcomes, comparable to National data from the United Kingdom. Smoking, previous breast radiation therapy, axillary nodal clearance, high breast specimen weight and implant volume could negatively impact complications and implant loss rates. Patient-reported outcomes need to be evaluated.
CharacteristicsNumber of patients or proceduresTotal number of patients822Total number of procedures1020Age (years)49BMI (kg/m2)25LateralityUnilateral624 (75.91)Bilateral198 (24.09)Smoker49 (4.80)Diabetes12 (1.17)Vascular disease11 (1.08)Previous breast surgery156 (15.30)Previous breast radiotherapy34 (3.33)
Neoadjuvant chemotherapy122 (14.85)Reconstruction typeImmediate849 (83.23)Delayed25 (2.45)Missing146 (14.32)Management of axillaSentinel node biopsy457 (44.80)Axillary nodal clearance112 (10.98)None320 (31.37)Missing131 (12.85)Type of reconstructionOne-stage823 (80.68)Two-stage112 (10.98)Missing85 (8.34)Hospital stay (days)1 (0-10)Breast specimen weight (grams)391 (64-3900)Implant size (cc)385 (100-700)HistologyInvasive ductal carcinoma392 (38.43)Invasive lobular carcinoma47 (4.61)Ductal carcinoma in-situ167 (16.37)Lobular carcinoma in-situ11 (1.08)Not applicable276 (27.06)Missing127 (12.45)Adjuvant chemotherapy167 (20.32)Adjuvant radiation therapy166 (16.27)
Citation Format: Mihir Chandarana, Sankaran Narayanan, Rishikesh Parmeshwar. Long-term results of prepectoral implant-based reconstruction using braxon®acellular dermal matrix - national audit from United Kingdom [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-09.