Breast Reconstruction
On this page you will find information about and links to relevant breast reconstruction publications
The Pre-bra study has recently been published by Kate Harvey et al in the BJS. Consecutive patients electing to undergo immediate PPBR at participating UK centres between July 2019 and December 2020 were invited to participate. 347 women underwent 424 immediate implant-based reconstructions at 40 centres. Most were single-stage direct-to-implant (357, 84.2 per cent) biological mesh-assisted (341, 80.4 per cent) procedures. Conversion to subpectoral reconstruction was necessary in four patients (0.9 per cent) owing to poor skin-flap quality. Of the 343 women who underwent PPBR, 144 (42.0 per cent) experienced at least one postoperative complication. Implant loss occurred in 28 women (8.2 per cent), 67 (19.5 per cent) experienced an infection, 60 (17.5 per cent) were readmitted for a complication, and 55 (16.0 per cent) required reoperation within 3 months of reconstruction. These findings support the need for a well-designed RCT comparing prepectoral and subpectoral reconstruction to establish best practice for implant-based breast reconstruction.
You can read more about it here.
Thiruchelvam et al have recently reported on their study, PRADA, to explore the feasibility of preoperative radiotherapy followed by skin-sparing mastectomy and deep inferior epigastric perforator (DIEP) flap reconstruction in patients with breast cancer requiring mastectomy. This was a prospective, non-randomised, feasibility study at two National Health Service trusts in the UK. Preoperative radiotherapy started 3-4 weeks after neoadjuvant chemotherapy and was delivered to the breast, plus regional nodes as required. Between Jan 25, 2016, and Dec 11, 2017, 33 patients were enrolled. At 4 weeks after surgery, four (12·1%, 95% CI 3·4-28·2) of 33 patients had an open breast wound greater than 1 cm. One (3%) patient had confluent moist desquamation (grade 3). There were no serious treatment-related adverse events and no treatment-related deaths. The study concluded that preoperative radiotherapy followed by skin-sparing mastectomy and immediate DIEP flap reconstruction is feasible and technically safe, with rates of breast open wounds similar to those reported with post-mastectomy radiotherapy. A randomised trial comparing preoperative radiotherapy with post-mastectomy radiotherapy is required to precisely determine and compare surgical, oncological, and breast reconstruction outcomes, including quality of life.
Link for the full text.
Summary
This secondary analysis of the Mastectomy Reconstruction Outcomes Consortium study aims to compare Patient Reported Outcomes (PROs) of women who underwent immediate implant-based breast reconstruction after receiving nipple sparing mastectomy (NSM) versus mastectomy with subsequent nipple reconstruction. Of the 600 women in the study, 47.7% underwent NSM. Analysis of BREAST-Q scores showed no significant differences in satisfaction with breast, psychosocial well-being, physical well-being or sexual well-being. Mastectomy type was not a significant predictor of complications or reconstructive failure.