Cook Hannah, Zargaran David, Glynou Sevasti Panagiota, Zargaran Alexander, Akhavani Mo, Williams Norman, Hamilton Stephen, Mosahebi Afshin
Department of Plastic Surgery, Royal Free Hospital, UK; University College Hospital Division of Surgery and Interventional Science, UK.
Department of Plastic Surgery, Royal Free Hospital, UK; University College Hospital Division of Surgery and Interventional Science, UK.
J Plast Reconstr Aesthet Surg. 2024 Dec;99:23-29. doi: 10.1016/j.bjps.2024.09.041. Epub 2024 Sep 17.
Breast cancer is the most common malignancy among women in the United Kingdom. Surgical management commonly comprises mastectomy and reconstruction, of which implant-based breast reconstruction (IBBR) is the most prevalent. Acellular dermal matrices (ADM) are widely used in pre-pectoral IBBR; however, there is limited high-quality evidence supporting their efficacy. This study aimed to establish an equipoise via an expert consensus survey.
An online survey was designed with a steering group of experts. Questions covered participant information, opinions regarding surgical outcomes with ADM use in pre-pectoral IBBR and opinions regarding the available scientific evidence on the topic. The survey was advertised via national and international professional organisations. Quantitative and qualitative analyses were performed.
Thirty-two participants from the UK, Italy and Australia completed the survey. Key findings of this study included disagreement among participants regarding the surgical outcomes associated with ADM use. Participants who believed that ADM reduced the risk of short-term complications and implant failure/explantation comprised a minority (21.9%). Participants who felt that ADM use improved cosmetic outcomes and reduced long-term complications were a relative majority at 43.8% and 40.6%, respectively. Furthermore, 56.3% of the participants felt that there was scarce scientific evidence on the topic.
This study provides insights from international surgeons, establishing a lack of consensus on surgical outcomes, efficacy and evidence-base supporting the use of ADMs in pre-pectoral IBBR. Given this clinical equipoise, alongside the growing burden of breast cancer associated morbidity and need for reconstruction, the implications of this study are that large-scale, prospective, randomised-controlled data are needed to establish whether ADM use in pre-pectoral breast reconstruction improves the outcomes.
乳腺癌是英国女性中最常见的恶性肿瘤。手术治疗通常包括乳房切除术和重建术，其中基于植入物的乳房重建（IBBR）最为普遍。脱细胞真皮基质（ADM）广泛应用于胸肌前IBBR；然而，支持其疗效的高质量证据有限。本研究旨在通过专家共识调查达成一种平衡。
在专家指导小组的参与下设计了一项在线调查。问题涵盖参与者信息、关于在胸肌前IBBR中使用ADM的手术结果的意见以及关于该主题现有科学证据的意见。该调查通过国家和国际专业组织进行宣传。进行了定量和定性分析。
来自英国、意大利和澳大利亚的32名参与者完成了调查。本研究的主要发现包括参与者对与使用ADM相关的手术结果存在分歧。认为ADM降低短期并发症风险以及植入物失败/取出风险的参与者占少数（21.9%）。认为使用ADM改善美容效果并减少长期并发症的参与者相对较多，分别为43.8%和40.6%。此外，56.3%的参与者认为关于该主题的科学证据稀少。
本研究提供了国际外科医生的见解，表明在胸肌前IBBR中使用ADM的手术结果、疗效和证据基础缺乏共识。鉴于这种临床平衡，以及与乳腺癌相关的发病率不断增加和重建需求，本研究的意义在于需要大规模、前瞻性、随机对照数据来确定在胸肌前乳房重建中使用ADM是否能改善结果。
