title: Single-stage immediate breast reconstruction with acellular dermal matrix: Experience gained and lessons learnt from patient reported outcome measures.
abstract: BACKGROUND
  Acellular Dermal Matrix (ADM) assisted breast reconstruction has transformed the single-stage Immediate Breast Reconstruction (IBR) with an impact on the cosmetic outcomes. However, there is limited data available on patient reported outcomes. This study highlights the Patient Reported Outcome Measures (PROMs), post-operative complications and lessons learnt from ADM assisted single-stage immediate breast reconstruction.
  
  
  METHODS
  This prospective study enrolled consecutive patients from Feb 2012 - May 2015 undergoing mastectomy with direct-to-implant ADM assisted breast reconstruction, using Strattice™ (Acelity, San Antonio, TX, USA). Patients were recruited from the beginning of our unit's use of ADMs and completed a post-operative questionnaire at 6 weeks, covering pre-operative, operative and post-operative outcomes. Information on tumour biology and post-operative complications was obtained from the medical notes.
  
  
  RESULTS
  This study included 49 patients undergoing a total of 53 procedures. Following surgery 93.3% of women reported a high level of body confidence when clothed. 6.7% of patients reported severe post-operative pain during the first week. Mean length of hospital stay was 1.7 days, return to light activities was within 2.5 weeks and normal activities in 5.4 weeks. Implant loss at 3 months occurred in 5.7% of procedures, of which two thirds were smokers.
  
  
  CONCLUSIONS
  PROMs for Strattice™ ADM based reconstruction show high levels of satisfaction with cosmetic outcomes, low incidences of severe post-operative pain and a short recovery process. PROMs help us to better describe patients' experience, allowing women to make more informed choices about ADM based breast reconstruction, which reassures and helps to achieve better outcomes.
authors.affiliation: Colchester Hospital University NHS Foundation Trust, Colchester General Hospital, Turner Rd, Essex, CO4 5JL, UK. Electronic address: anuapte@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Apte
authors.affiliation: Colchester Hospital University NHS Foundation Trust, Colchester General Hospital, Turner Rd, Essex, CO4 5JL, UK. Electronic address: maia.walsh@hotmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Walsh
authors.affiliation: Colchester Hospital University NHS Foundation Trust, Colchester General Hospital, Turner Rd, Essex, CO4 5JL, UK. Electronic address: Sekharan.Chandra@colchesterhospital.nhs.uk.
authors.forename: S
authors.initials: S
authors.lastname: Chandrasekharan
authors.affiliation: Colchester Hospital University NHS Foundation Trust, Colchester General Hospital, Turner Rd, Essex, CO4 5JL, UK. Electronic address: arunmoy.chakravorty@colchesterhospital.nhs.uk.
authors.forename: A
authors.initials: A
authors.lastname: Chakravorty
mesh_terms: D062088:Acellular Dermis; D000328:Adult; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D006801:Humans; D007902:Length of Stay; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D010149:Postoperative Pain / Q000503:physiopathology; D063868:Patient Outcome Assessment; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000503:physiopathology / Q000628:therapy; D011446:Prospective Studies; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D015626:Tissue Expansion / Q000379:methods; D016896:Treatment Outcome; D006113:United Kingdom; D014945:Wound Healing / Q000502:physiology
keywords: Acellular dermal matrix; Patient reported outcome measures