One-stage direct-to-implant breast reconstruction using acellular dermal matrix
Mené aux Pays-Bas sur 142 patientes atteintes d'un cancer du sein, cet essai randomisé compare l'intérêt, du point de vue esthétique, de la satisfaction des patientes et de leur qualité de vie, d'une reconstruction mammaire en deux étapes avec pose d'implants mammaires et d'une reconstruction mammaire immédiate par prothèse avec matrice dermique acellulaire
In their Article published in The Lancet Oncology, Vera Lidwina Negenborn and colleagues report primary outcomes for the Breast Reconstruction in One Stage (BRIOS) trial. This is the first randomised study comparing one-stage implant-based breast reconstruction (IBBR) using acellular dermal matrix (ADM) with a conventional two-stage procedure in which a tissue expander is exchanged for a definitive implant once expansion is complete. Introduction of ADM as a surgical adjuvant was intended to offset the disadvantages of a two-stage approach, including treatment duration and complications secondary to suboptimal muscular and fascial coverage of the implant. Thus, ADM would avoid the need for a separate expansion phase by creating a compound pocket of matrix and muscle with sufficient fill-volume to allow placement of a permanent prosthesis during the initial surgery. Furthermore, superior aesthetic results were expected, such as improved shape and contour of the lower pole together with re-creation and better definition of the inframammary fold.
The Lancet Oncology , commentaire, 2017