Breast Reconstruction Outcomes With and without StratticE (BROWSE)- Long-term outcomes of a multi-centre study comparing Strattice TM immediate implant breast reconstruction with submuscular implant reconstruction

Abstract

Background: Over half of immediate implant-based breast reconstructions (IBBR) are performed with an acellular dermal matrix (ADM), despite limited long-term outcome data. Methods: The Breast Reconstruction Outcomes With and without StratticE (BROWSE) (NCT02608593) study was a retrospective multicentre cohort study comparing consecutive patients who had undergone immediate StratticeTM IBBR with those who had undergone immediate IBBR with a submuscular technique between January 2009 and December 2015. Results: This study compared 553 StratticeTM reconstructions with 242 submuscular reconstructions, with a median follow-up of 4.3 years (range 2 - 9.3) and 5.7 years (range 2 - 8.1) respectively, demonstrating an equivalent total complication rate (Strattice TM 36.9% (n=204) vs. submuscular 31.8% (n=77),p=0.17) and implant loss rate (8.5% vs. 5.4%, p=0.12, respectively). Infection rates and wound dehiscence rates were higher in the StratticeTM cohort (20.6% (n=114) vs. 12.8% (n=31), p=0.009 and 16.3% (n=90) vs. 10.4% (n=25), p=0.03, respectively). Overall revision rates were comparable (46.7% (n=226) vs. 41.1% (n=79), p=0.2) but significantly less StratticeTM reconstructions required revision surgery for capsular contracture (5.3% vs. 15.6%, p<0.001). Conclusions: Although the risk of complications associated with StratticeTM reconstruction is numerically higher than that for submuscular coverage, the difference is small and not statistically significant, and likely outweighed by the clear reduced rate of revision surgery due to capsular contracture when Strattice TM is used.