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Direct-to-Implant Breast Reconstruction without the Use of an Acellular Dermal Matrix Is Cost Effective and Oncologically Safe

Serrurier, L. Charles. J. F.C.S.(Plast.Surg.)(C.M.S.A.); Rayne, Sarah B.Sc.(U.C.L.), M.R.C.S.(Eng.), F.C.S.(S.A.); Venter, Marisse F.C.S.(Plast.Surg.)(C.M.S.A.); Benn, Carol-Ann F.C.S.(S.A.)

Plastic & Reconstructive Surgery: April 2017 - Volume 139 - Issue 4 - p 809–817
doi: 10.1097/PRS.0000000000003222
Breast: Original Articles

Background: Direct-to-implant breast reconstruction is a predictable, reliable, and cost-effective reconstruction. Most units performing direct-to-implant reconstructions recommend the use of an acellular dermal matrix or a mesh to reinforce the lower pole of the breast reconstruction.

Methods: Two hundred seventy-two consecutive patients with 488 immediate direct-to-implant breast reconstructions performed in a 34-month period are included in this group. Mean follow-up of this group is 35 months.

Results: Four hundred eight reconstructions were performed through a lazy-S mastectomy, and 80 were performed through a Wise pattern mastectomy. Two local recurrences occurred. Minor complications accounted for 5.5 percent (n = 27): seromas, 3.4 percent (n = 17); wound healing problems, 0.6 percent (n = 3); and grade 2 capsular contracture, 1.4 percent (n = 7). Major complications accounted for 4.3 percent (n = 21): infection, 0.8 percent (n = 4); prosthetic loss, 0.4 percent (n = 2); hematoma, 0.4 percent (n = 2); and wounds requiring débridement, 2 percent (n = 10). The additional cost of acellular dermal matrix is dependent on manufacturer and size, but increases the cost of the procedure by 35.5 to 47.7 percent.

Conclusions: This reconstruction method compares very favorably with published data from other units as far as early and late complications and cosmetic outcome are concerned. It has a complication rate similar to that of reconstructions using an acellular dermal matrix and is more cost effective.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Johannesburg, South Africa

From the University of the Witwatersrand and Milpark Breast Care Centre of Excellence.

Received for publication January 15, 2016; accepted September 16, 2016.

Disclosure: None of the authors has a financial interest in any of the products or devices mentioned in this article.

L. Charles. J. Serrurier, F.C.S.(Plast.Surg.)(C.M.S.A.), Netcare Breastcare Centre of Excellence, Suit E, Milpark Hospital, 9 Guild Road, Parktown West, Johannesburg 2193, South Africa, drcserrurier@gmail.com

©2017American Society of Plastic Surgeons