Abstract: Acellular Dermal Matrix Sparing Direct to Implant Prepectoral Breast Reconstruction ā€“ A Comparative Study Including Cost Analysis (Plastic Surgery The Meeting (September 28

Sunday, September 30, 2018: 5:20 PM

Alex Viezel-Mathieu, MD, CM , Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, QC, Canada

Nayif M Alnaif, MD , Plastic Surgery, McGill University, Montreal, QC, Canada

Albaraa A Aljerian, MD , Plastic Surgery, McGill University, Montreal, QC, Canada

Jean-Francois Boileau, MD, MSc, FRCSC , Department of Surgery, Jewish General Hospital, Montreal, QC, Canada

Tassos Dionisopoulos, MD, MSc, FRCSC , Division of Plastic and Reconstructive Surgery, McGill University, Montréal, QC, Canada

Purpose:

There has a been a resurgence in popularity of prepectoral reconstruction, with the advent of new technologies and materials such as acellular dermal matrix (ADM), form stable silicone gel implants and intra-operative tissue perfusion analysis.

Our centre has been utilizing a direct to implant prepectoral (DTI PP) reconstruction technique for over two years. This paper aims to revisit the notion of immediate DTI PP breast reconstruction and provide our university academic teaching centre single surgeon experience. A cost analysis is also presented and compared to traditional subpectoral two-stage reconstruction.

Methods

Clinic log books were used to identified all patients who underwent DTI PP breast reconstruction with ADM over an 18-month period. A comparison group composed of patients having undergone traditional two-stage subpectoral reconstruction with ADM were also reviewed. A full electronic medical record review was performed. All countable variables were included in the cost analysis.

Results

A total of 77 patients representing 116 reconstructed breasts were included. The prepectoral group was composed of 39 patients and 60 breasts and the subpectoral group of 38 patients and 56 breasts. Patient demographics including age, diabetic and smoking status and neo-adjuvant chemo were similar for both groups.

When compared to the traditional two-stage subpectoral reconstruction, patients having undergone DTI PP reconstruction benefited from fewer complications (24.7% vs. 35.6% respectively), fewer follow-up visits (3.8 vs. 5.4 respectively) and no animation deformity.

DTI PP reconstruction proved to be 25% less expensive than two-stage subpectoral reconstruction when all associated costs were considered ($17 243 vs. $22 716 CAD respectively).

Conclusion

Using proper patient selection, form stable implants and ADM’s, reconstruction breast surgeons are now able to provide safe and consistent results using the prepectoral technique. Additionally, prepectoral reconstruction appears to be cost effective with a similar complication profile.

34337 Acellular Dermal Matrix Sparing Direct to Implant Prepectoral Breast Reconstruction ā€“ A Comparative Study Including Cost Analysis