Clinical and patient reported outcomes in breast reconstruction using acellular dermal matrix

There is a lack of published patient reported outcome measures (PROMs) for the use of acellular dermal matrix (ADM) based breast reconstruction. This cohort study reviewed our clinical outcomes and PROMs.

All patients undergoing mastectomy with ADM assisted immediate breast reconstruction under a single surgeon between June 2013 and June 2017 were included. A prospectively kept database, clinic letters and operation notes were analysed. All patients received BREAST-Q^TM pre and post-operative questionnaires.

Sixty-two consecutive patients with 77 reconstructions were included. Mean hospital stay was 3.3 days. All patients received 48 h of intravenous antibiotics, followed by a two-week course of oral antibiotics. Mean post-operative follow up was 17 months. There were 8 cases of skin necrosis (10.4%), and 1 infection (1.3%). These resulted in 4 explantations (5.2%); 3 following skin necrosis and 1 following infection. There was no observed 'red skin' syndrome. Post-operative mean score for 'satisfaction with outcome' was 83.1%. Mean score for 'Psychosocial well-being' was 70.7% and the mean score for 'physical well-being' was 77.9%.

Our complication rates were comparable to those published, and PROMs were consistently good. The skin necrosis rate was potentially due to earlier practice of performing single-stage immediate reconstruction using fixed volume breast implants. We have modified our patient selection criteria and ADM based reconstructive techniques with experience. Longer term clinical and patient reported outcome should be sought.