Reconstruction referendum.

Top Line: Brits are re-thinking everything, and one of those things is immediate implant-based reconstruction using mesh after mastectomy.
The Study: Implant-based reconstruction is the most common type of post-mastectomy reconstruction. It typically involves a two-step procedure where tissue expanders are placed first and expanded over time to create an adequately-sized pocket for the full implant, which is placed at a later date. More recently, mesh has been used to perform a single-step procedure. It’s interesting enough that you should look up a picture. It involves the use of a biologic or synthetic mesh to create a sling for the implant to be immediately placed in either a subpectoral or prepectoral position. Sounds great. Except this incredibly common aspect of breast cancer treatment has not been as rigorously studied as, say, axillary dissections. The prospective observational iBRA study was uniquely designed to assess over 2000 women enrolled after immediate mesh and implant-based reconstruction in the UK. The results were disappointing: Nearly one in five patients required readmission and/or reoperation due to complications within 3 months of initial surgery with one in ten suffering implant loss. In addition, a quarter of all patients required treatment for infection.
Bottom Line: Complication rates for immediate implant-based reconstruction are high and underlie the importance of prospective surgical data in post-mastectomy reconstruction. | Potter, Lancet Oncol 2019


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