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Immediate direct-to-implant breast reconstruction with acellular dermal matrix: Evaluation of complications and safety
OBJECTIVE: Immediate direct-to-implant breast reconstruction with acellular dermal matrix (ADM) is the method of choice for many plastic surgeons and patients, but the use of ADM remains a controversial subject in the literature. This study aimed to investigate complications, reconstructive failure...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8551207/ https://www.ncbi.nlm.nih.gov/pubmed/34688959 http://dx.doi.org/10.1016/j.breast.2021.10.006 |
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author | Kalstrup, Julie Balslev Willert, Cecilie Brinch-Møller Weitemeyer, Marie Hougaard Chakera, Annette Hölmich, Lisbet Rosenkrantz |
author_facet | Kalstrup, Julie Balslev Willert, Cecilie Brinch-Møller Weitemeyer, Marie Hougaard Chakera, Annette Hölmich, Lisbet Rosenkrantz |
author_sort | Kalstrup, Julie |
collection | PubMed |
description | OBJECTIVE: Immediate direct-to-implant breast reconstruction with acellular dermal matrix (ADM) is the method of choice for many plastic surgeons and patients, but the use of ADM remains a controversial subject in the literature. This study aimed to investigate complications, reconstructive failure and possible risk factors in direct-to-implant breast reconstruction with ADM (primarily Strattice™). METHODS: We retrospectively examined all patients undergoing immediate direct-to-implant breast reconstruction with ADM, during a five-year period (2014–2019) at a university clinic. Study outcomes were all complications and explantations. Complications were stratified within and after 6 months postoperatively and subcategorized by type of intervention. Explantations were subcategorized into loss of implant or salvage with immediate insertion of a tissue expander, the same or a new implant. RESULTS: We included 154 patients and 232 breasts. Complications within 6 months per patient included hematoma (4%), seroma (8%), infection (9%), necrosis, wound dehiscence and delayed wound healing (19%). The total complication rate per patient was 34%. Explantation occurred in 20 patients (13%) of which 9 (6% of all) had implant loss. Preoperative radiotherapy was a significant predictor of explantation (adjusted OR 4.9, 95% confidence interval (CI), 1.0–23.5; p = 0.045), and smoking was also associated with risk of explantation, although only borderline significant (adjusted OR 4.0, 95% CI, 1.0–15.8; p = 0.050). CONCLUSION: This study demonstrates acceptable rates of re-operations and implant loss compared to other studies but highlights the importance of proper patient selection with regards to risk factors to minimize complications. |
format | Online Article Text |
id | pubmed-8551207 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-85512072021-11-04 Immediate direct-to-implant breast reconstruction with acellular dermal matrix: Evaluation of complications and safety Kalstrup, Julie Balslev Willert, Cecilie Brinch-Møller Weitemeyer, Marie Hougaard Chakera, Annette Hölmich, Lisbet Rosenkrantz Breast Original Article OBJECTIVE: Immediate direct-to-implant breast reconstruction with acellular dermal matrix (ADM) is the method of choice for many plastic surgeons and patients, but the use of ADM remains a controversial subject in the literature. This study aimed to investigate complications, reconstructive failure and possible risk factors in direct-to-implant breast reconstruction with ADM (primarily Strattice™). METHODS: We retrospectively examined all patients undergoing immediate direct-to-implant breast reconstruction with ADM, during a five-year period (2014–2019) at a university clinic. Study outcomes were all complications and explantations. Complications were stratified within and after 6 months postoperatively and subcategorized by type of intervention. Explantations were subcategorized into loss of implant or salvage with immediate insertion of a tissue expander, the same or a new implant. RESULTS: We included 154 patients and 232 breasts. Complications within 6 months per patient included hematoma (4%), seroma (8%), infection (9%), necrosis, wound dehiscence and delayed wound healing (19%). The total complication rate per patient was 34%. Explantation occurred in 20 patients (13%) of which 9 (6% of all) had implant loss. Preoperative radiotherapy was a significant predictor of explantation (adjusted OR 4.9, 95% confidence interval (CI), 1.0–23.5; p = 0.045), and smoking was also associated with risk of explantation, although only borderline significant (adjusted OR 4.0, 95% CI, 1.0–15.8; p = 0.050). CONCLUSION: This study demonstrates acceptable rates of re-operations and implant loss compared to other studies but highlights the importance of proper patient selection with regards to risk factors to minimize complications. Elsevier 2021-10-15 /pmc/articles/PMC8551207/ /pubmed/34688959 http://dx.doi.org/10.1016/j.breast.2021.10.006 Text en © 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Original Article Kalstrup, Julie Balslev Willert, Cecilie Brinch-Møller Weitemeyer, Marie Hougaard Chakera, Annette Hölmich, Lisbet Rosenkrantz Immediate direct-to-implant breast reconstruction with acellular dermal matrix: Evaluation of complications and safety |
title | Immediate direct-to-implant breast reconstruction with acellular dermal matrix: Evaluation of complications and safety |
title_full | Immediate direct-to-implant breast reconstruction with acellular dermal matrix: Evaluation of complications and safety |
title_fullStr | Immediate direct-to-implant breast reconstruction with acellular dermal matrix: Evaluation of complications and safety |
title_full_unstemmed | Immediate direct-to-implant breast reconstruction with acellular dermal matrix: Evaluation of complications and safety |
title_short | Immediate direct-to-implant breast reconstruction with acellular dermal matrix: Evaluation of complications and safety |
title_sort | immediate direct-to-implant breast reconstruction with acellular dermal matrix: evaluation of complications and safety |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8551207/ https://www.ncbi.nlm.nih.gov/pubmed/34688959 http://dx.doi.org/10.1016/j.breast.2021.10.006 |
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