Biological and Synthetic Mesh in Breast Reconstructive Surgery
Author: Mette Eline Brunbjerg, MD, PhD
Supervisors: Peer Christiansen, MD, DMSc, Professor, Jens Overgaard, MD, DMSc, Professor and Tine Engberg Damsgaard, MD, PhD, MRBS, Professor
Date, Institution and University: 2020, Department of Plastic and Breast Surgery, Aarhus University Hospital
The present PhD thesis investigates the potential benefits of ADM (acellular dermal matrix) use in breast reconstructive procedures.
Study I and II investigates whether ADM assisted one-stage implant-based BR (breast reconstruction) minimizes the risk of complications, costs, and surgical procedures and furthermore, improves the outcome evaluated by PROMs (patient reported outcome measures) and evaluation of the aesthetic result compared to traditional two-stage expander-to-implant BR. Study results did not provide unambiguous results concerning costs associated with the two treatment methods. However, statistically significant more surgical interventions were performed in the one-stage group to obtain an aesthetical satisfying result. The two treatment groups reported equally good results in PROMs, and evaluation of the aesthetic results and symmetry were also comparable. Furthermore, no statistically significant difference was observed regarding implant loss, implant exchange, and major complications. However, the two-stage group had
significantly more minor complications. In conclusion, it is proposed that the ADM assisted one-stage approach may be feasible for selected patients and allow the patients to achieve an implant-based breast reconstruction with a minimum of surgeries and outpatient visits. But the patients should be well informed of the potential need for additional interventions to obtain an aesthetically satisfying result.
Study III investigates whether the use of ADM for reinforcement of the abdominal donor-site after BR with the pedicled TRAM (transverse rectus abdominis musculocutaneous) flap result in less bulging or herniation and decreased abdominal pain and discomfort compared to reinforcement with synthetic mesh. The study did not demonstrate any statistically significant differences between treatment groups regarding the risk of bulging or hernia, postoperative abdominal muscle strength, complications, pain, or HrQoL (health related quality of life) within two years of follow-up. In conclusion, the proposed advantages of ADM use for reinforcement of the abdominal donor-site could not be confirmed.
Further research, in a larger setting preferably including multiple centers and if possibly the RCT (randomized controlled trial) study design, is needed to further investigate the role of ADM in breast reconstructive procedures.