Dua Hashmiand Tarannum Fasih
Introduction: StratticeTM is a porcine acellular dermal matrix used in breast reconstruction. It acts as a hammock for breast implants and to define the infra mammary fold.
Method: All patients who underwent StratticeTM based reconstruction from 2010-15 under the care of one breast surgeon were included in this study. The StratticeTM matrix was used to create the sub pectoral pouch in which the implant was placed. Patients were divided into 2 Groups based on radiation therapy to the breast either before or after surgery (Group A) and those who received no radiation at any stage (Group B). Data regarding indication for surgery, size of implant, follow up time and significant complications were collected and analyzed using Windows Excel. Statistical analysis was performed using Chi-Squared test to compare the complications between the 2 Groups. A subgroup analysis was performed based on either breast surgery with skin sparing mastectomy and immediate reconstruction (SSM and IR), delayed reconstruction (DR) or re-do reconstruction (RR).
Results: There were 76 cases with average age of 52 years (33-79). There were 30 cases in Group A and 46 in Group B. In Group A, 14 patients had IR, 15 DR and 1 RR. 3 patients had previous lumpectomy and radiation treatment for breast cancer followed by SSM and IR. In Group B, 25 had IR, 20 had DR and 1 had IR. The average size of implant used was 422 gms (195-765 gms). Follow up time was 27 months (1-62). In Group A there were 2 cases of infection, 1 case of capsule contracture and 2 wound breakdowns. 5 mastectomy flaps failed to stretch due to poor skin compliance secondary to radiation to the chest wall. There was 1 case of bottoming out of the implant in this Group requiring RR. In Group B, there was 1 case of extrusion requiring RR and 1 case of flap necrosis. Group A had more complications and implant loss than Group B and this was found to be statistically significant (p<0.0007).
Conclusion: StratticeTM based breast reconstruction post radiotherapy carries higher risk of complications and abandoning due to non-compliant skin. This elevated risk should be emphasized to the patients and autologous flaps should be considered in these cases.