Abstract
Abstract
Background
Breast cancer is the most common malignancy among women in the UK. Following mastectomy, reconstruction is now integral to the surgical management of breast cancer, of which implant-based reconstruction (IBBR) is the most common type. IBBR initially evolved from pre-pectoral to post-pectoral due to complications, but with developments in oncoplastic techniques and new implant technology, interest in pre-pectoral IBBR has increased.
Many surgeons use acellular dermal matrices (ADM); however, there is little evidence in literature as to whether this improves surgical outcomes in terms of complications, failure and patient satisfaction. This review aims to assess the available evidence as to whether there is a difference in surgical outcomes for breast reconstructions using ADM versus non-use of ADM.
Methods
A database search will be performed using Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Clinicaltrials.org. The search timeframe will be 10 years.
Studies will be screened using inclusion and exclusion criteria and data extracted into a standardised spreadsheet. Risk of bias will be assessed. Screening, extraction and risk-of-bias assessments will be performed independently by two reviewers and discrepancies discussed and rectified. Data analysis and meta-analysis will be performed using Microsoft Excel and R software. Forest plots will be used for two-arm studies to calculate heterogeneity and p-value for overall effect.
Discussion
With the renaissance of pre-pectoral IBBR, it is important that surgeons have adequate evidence available to assist operative decision-making. Assessing evidence in literature is important to help surgeons determine whether using ADM for IBBR is beneficial compared to non-use of ADM. This has potential impacts for patient complications, satisfaction and cost to healthcare trusts.
Systematic review registration
PROSPERO 2023 CRD42023389072.
Publisher
Springer Science and Business Media LLC
Reference18 articles.
1. House of Commons Library. Cancer: summary of statistics (England). 2021. Available from: https://commonslibrary.parliament.uk/research-briefings/sn06887/. Accessed 05/10/2023.
2. Duffy S, Vulkan D, Cuckle H, Parmar D, Sheikh S, Smith R, et al. Annual mammographic screening to reduce breast cancer mortality in women from age 40 years: long-term follow-up of the UK Age RCT. Health Technol Assess (Rockv). 2020;24(55):1–24.
3. Freeman MD, Gopman JM, Salzberg CA. The evolution of mastectomy surgical technique: from mutilation to medicine. Gland Surg. 2018;7(3):308–15.
4. Weinzierl A, Schmauss D, Brucato D, Harder Y. Implant-based breast reconstruction after mastectomy, from the subpectoral to the prepectoral approach: an evidence-based change of mind? J Clin Med. 2022;11(11):3079.
5. Uroskie TW, Colen LB. History of breast reconstruction. Semin Plast Surg. 2004;18(2):65–9.