Single-stage breast reconstruction using Strattice™: A retrospective study

R E G Dikmans, F El Morabit, M J Ottenhof, S M H Tuinder, J W R Twisk, C Moues, M B Bouman, M G Mullender

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

INTRODUCTION: Strattice™, a porcine acellular dermal matrix, has emerged as a product to augment implant-based breast reconstruction. It aims to resolve problems related to poor tissue coverage of the implant. Presently, evidence justifying the use of Strattice in breast reconstruction is lacking. The objective of this study is to assess the clinical outcomes of a patient cohort that underwent single-stage implant-based breast reconstruction with the additional use of Strattice.

METHODS: We conducted a retrospective chart review of patients who underwent single-stage breast reconstruction with the use of Strattice. All cases of breast reconstruction after oncologic or prophylactic mastectomy between 2010 and 2014 in one of eight different centres in the Netherlands were included. Patient demographics, treatment characteristics and clinical outcome data were collected. The outcomes were presented using descriptive statistics, and the associations were evaluated using Fisher's exact test.

RESULTS: Eighty-eight patients who underwent either unilateral (60 patients) or bilateral (25 patients) (n = 110 breasts) single-stage breast reconstruction with the use of Strattice were identified. The indication for mastectomy was therapeutic in 69.1% (76) of cases and prophylactic in 30.9% (34) of cases. The reported minor complications included seroma (20.9%), skin necrosis (20.0%), wound dehiscence (11.8%), erythema/inflammation (14.5%) and infection (11.8%). In 22 breasts (22.7%), reoperation was necessary, with explantation of the implant in 11 breasts (11.8%).

CONCLUSIONS: In this cohort, the total complication rate was very high (78%). Although most complications were minor, reoperation was performed in 22.7%, with explantation of the implant in 11.8% of breasts. We suggest that patient selection, experience of the surgeon and handling of early complications are factors playing a crucial role in the success of the operation. The use of a Strattice sheet in single-stage implant-based breast reconstruction may be a promising technique, but more evidence from prospective, randomized studies is necessary to justify its use.

LEVEL OF EVIDENCE: IV.

Original languageEnglish
Pages (from-to)227-233
Number of pages7
JournalJournal of Plastic, Reconstructive and Aesthetic Surgery
Volume69
Issue number2
DOIs
Publication statusPublished - Feb 2016

Cite this

Dikmans, R E G ; El Morabit, F ; Ottenhof, M J ; Tuinder, S M H ; Twisk, J W R ; Moues, C ; Bouman, M B ; Mullender, M G. / Single-stage breast reconstruction using Strattice™ : A retrospective study. In: Journal of Plastic, Reconstructive and Aesthetic Surgery. 2016 ; Vol. 69, No. 2. pp. 227-233.
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title = "Single-stage breast reconstruction using Strattice™: A retrospective study",
abstract = "INTRODUCTION: Strattice™, a porcine acellular dermal matrix, has emerged as a product to augment implant-based breast reconstruction. It aims to resolve problems related to poor tissue coverage of the implant. Presently, evidence justifying the use of Strattice in breast reconstruction is lacking. The objective of this study is to assess the clinical outcomes of a patient cohort that underwent single-stage implant-based breast reconstruction with the additional use of Strattice.METHODS: We conducted a retrospective chart review of patients who underwent single-stage breast reconstruction with the use of Strattice. All cases of breast reconstruction after oncologic or prophylactic mastectomy between 2010 and 2014 in one of eight different centres in the Netherlands were included. Patient demographics, treatment characteristics and clinical outcome data were collected. The outcomes were presented using descriptive statistics, and the associations were evaluated using Fisher's exact test.RESULTS: Eighty-eight patients who underwent either unilateral (60 patients) or bilateral (25 patients) (n = 110 breasts) single-stage breast reconstruction with the use of Strattice were identified. The indication for mastectomy was therapeutic in 69.1{\%} (76) of cases and prophylactic in 30.9{\%} (34) of cases. The reported minor complications included seroma (20.9{\%}), skin necrosis (20.0{\%}), wound dehiscence (11.8{\%}), erythema/inflammation (14.5{\%}) and infection (11.8{\%}). In 22 breasts (22.7{\%}), reoperation was necessary, with explantation of the implant in 11 breasts (11.8{\%}).CONCLUSIONS: In this cohort, the total complication rate was very high (78{\%}). Although most complications were minor, reoperation was performed in 22.7{\%}, with explantation of the implant in 11.8{\%} of breasts. We suggest that patient selection, experience of the surgeon and handling of early complications are factors playing a crucial role in the success of the operation. The use of a Strattice sheet in single-stage implant-based breast reconstruction may be a promising technique, but more evidence from prospective, randomized studies is necessary to justify its use.LEVEL OF EVIDENCE: IV.",
keywords = "Acellular Dermis, Breast Implants, Breast Neoplasms/surgery, Female, Follow-Up Studies, Humans, Mammaplasty/methods, Mastectomy/methods, Middle Aged, Prosthesis Design, Reoperation, Retrospective Studies, Treatment Outcome",
author = "Dikmans, {R E G} and {El Morabit}, F and Ottenhof, {M J} and Tuinder, {S M H} and Twisk, {J W R} and C Moues and Bouman, {M B} and Mullender, {M G}",
note = "Copyright {\circledC} 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.",
year = "2016",
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Single-stage breast reconstruction using Strattice™ : A retrospective study. / Dikmans, R E G; El Morabit, F; Ottenhof, M J; Tuinder, S M H; Twisk, J W R; Moues, C; Bouman, M B; Mullender, M G.

In: Journal of Plastic, Reconstructive and Aesthetic Surgery, Vol. 69, No. 2, 02.2016, p. 227-233.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Single-stage breast reconstruction using Strattice™

T2 - A retrospective study

AU - Dikmans, R E G

AU - El Morabit, F

AU - Ottenhof, M J

AU - Tuinder, S M H

AU - Twisk, J W R

AU - Moues, C

AU - Bouman, M B

AU - Mullender, M G

N1 - Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

PY - 2016/2

Y1 - 2016/2

N2 - INTRODUCTION: Strattice™, a porcine acellular dermal matrix, has emerged as a product to augment implant-based breast reconstruction. It aims to resolve problems related to poor tissue coverage of the implant. Presently, evidence justifying the use of Strattice in breast reconstruction is lacking. The objective of this study is to assess the clinical outcomes of a patient cohort that underwent single-stage implant-based breast reconstruction with the additional use of Strattice.METHODS: We conducted a retrospective chart review of patients who underwent single-stage breast reconstruction with the use of Strattice. All cases of breast reconstruction after oncologic or prophylactic mastectomy between 2010 and 2014 in one of eight different centres in the Netherlands were included. Patient demographics, treatment characteristics and clinical outcome data were collected. The outcomes were presented using descriptive statistics, and the associations were evaluated using Fisher's exact test.RESULTS: Eighty-eight patients who underwent either unilateral (60 patients) or bilateral (25 patients) (n = 110 breasts) single-stage breast reconstruction with the use of Strattice were identified. The indication for mastectomy was therapeutic in 69.1% (76) of cases and prophylactic in 30.9% (34) of cases. The reported minor complications included seroma (20.9%), skin necrosis (20.0%), wound dehiscence (11.8%), erythema/inflammation (14.5%) and infection (11.8%). In 22 breasts (22.7%), reoperation was necessary, with explantation of the implant in 11 breasts (11.8%).CONCLUSIONS: In this cohort, the total complication rate was very high (78%). Although most complications were minor, reoperation was performed in 22.7%, with explantation of the implant in 11.8% of breasts. We suggest that patient selection, experience of the surgeon and handling of early complications are factors playing a crucial role in the success of the operation. The use of a Strattice sheet in single-stage implant-based breast reconstruction may be a promising technique, but more evidence from prospective, randomized studies is necessary to justify its use.LEVEL OF EVIDENCE: IV.

AB - INTRODUCTION: Strattice™, a porcine acellular dermal matrix, has emerged as a product to augment implant-based breast reconstruction. It aims to resolve problems related to poor tissue coverage of the implant. Presently, evidence justifying the use of Strattice in breast reconstruction is lacking. The objective of this study is to assess the clinical outcomes of a patient cohort that underwent single-stage implant-based breast reconstruction with the additional use of Strattice.METHODS: We conducted a retrospective chart review of patients who underwent single-stage breast reconstruction with the use of Strattice. All cases of breast reconstruction after oncologic or prophylactic mastectomy between 2010 and 2014 in one of eight different centres in the Netherlands were included. Patient demographics, treatment characteristics and clinical outcome data were collected. The outcomes were presented using descriptive statistics, and the associations were evaluated using Fisher's exact test.RESULTS: Eighty-eight patients who underwent either unilateral (60 patients) or bilateral (25 patients) (n = 110 breasts) single-stage breast reconstruction with the use of Strattice were identified. The indication for mastectomy was therapeutic in 69.1% (76) of cases and prophylactic in 30.9% (34) of cases. The reported minor complications included seroma (20.9%), skin necrosis (20.0%), wound dehiscence (11.8%), erythema/inflammation (14.5%) and infection (11.8%). In 22 breasts (22.7%), reoperation was necessary, with explantation of the implant in 11 breasts (11.8%).CONCLUSIONS: In this cohort, the total complication rate was very high (78%). Although most complications were minor, reoperation was performed in 22.7%, with explantation of the implant in 11.8% of breasts. We suggest that patient selection, experience of the surgeon and handling of early complications are factors playing a crucial role in the success of the operation. The use of a Strattice sheet in single-stage implant-based breast reconstruction may be a promising technique, but more evidence from prospective, randomized studies is necessary to justify its use.LEVEL OF EVIDENCE: IV.

KW - Acellular Dermis

KW - Breast Implants

KW - Breast Neoplasms/surgery

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Mammaplasty/methods

KW - Mastectomy/methods

KW - Middle Aged

KW - Prosthesis Design

KW - Reoperation

KW - Retrospective Studies

KW - Treatment Outcome

U2 - 10.1016/j.bjps.2015.11.008

DO - 10.1016/j.bjps.2015.11.008

M3 - Article

VL - 69

SP - 227

EP - 233

JO - Journal of Plastic, Reconstructive and Aesthetic Surgery

JF - Journal of Plastic, Reconstructive and Aesthetic Surgery

SN - 1748-6815

IS - 2

ER -