title: Single-stage breast reconstruction using Strattice™: A retrospective study.
abstract: BACKGROUND
  Strattice™, a porcine acellular dermal matrix, has emerged as a product to augment implant-based breast reconstruction. It aims to resolve problems related to poor tissue coverage of the implant. Presently, evidence justifying the use of Strattice in breast reconstruction is lacking. The objective of this study is to assess the clinical outcomes of a patient cohort that underwent single-stage implant-based breast reconstruction with the additional use of Strattice.
  
  
  METHODS
  We conducted a retrospective chart review of patients who underwent single-stage breast reconstruction with the use of Strattice. All cases of breast reconstruction after oncologic or prophylactic mastectomy between 2010 and 2014 in one of eight different centres in the Netherlands were included. Patient demographics, treatment characteristics and clinical outcome data were collected. The outcomes were presented using descriptive statistics, and the associations were evaluated using Fisher's exact test.
  
  
  RESULTS
  Eighty-eight patients who underwent either unilateral (60 patients) or bilateral (25 patients) (n = 110 breasts) single-stage breast reconstruction with the use of Strattice were identified. The indication for mastectomy was therapeutic in 69.1% (76) of cases and prophylactic in 30.9% (34) of cases. The reported minor complications included seroma (20.9%), skin necrosis (20.0%), wound dehiscence (11.8%), erythema/inflammation (14.5%) and infection (11.8%). In 22 breasts (22.7%), reoperation was necessary, with explantation of the implant in 11 breasts (11.8%).
  
  
  CONCLUSIONS
  In this cohort, the total complication rate was very high (78%). Although most complications were minor, reoperation was performed in 22.7%, with explantation of the implant in 11.8% of breasts. We suggest that patient selection, experience of the surgeon and handling of early complications are factors playing a crucial role in the success of the operation. The use of a Strattice sheet in single-stage implant-based breast reconstruction may be a promising technique, but more evidence from prospective, randomized studies is necessary to justify its use.
  
  
  METHODS
  IV.
authors.affiliation: Department of Plastic, Reconstructive & Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: r.dikmans@vumc.nl.
authors.forename: R E G
authors.initials: RE
authors.lastname: Dikmans
authors.affiliation: Department of Plastic, Reconstructive & Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: El Morabit
authors.affiliation: Department of Plastic, Reconstructive & Hand Surgery, BovenIJ Hospital, Amsterdam, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Ottenhof
authors.affiliation: Department of Plastic, Reconstructive & Hand Surgery, Maastricht University Medical Center/NUTRIUM, Maastricht, Maastricht, The Netherlands.
authors.forename: S M H
authors.initials: SM
authors.lastname: Tuinder
authors.affiliation: Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: J W R
authors.initials: JW
authors.lastname: Twisk
authors.affiliation: Department of Plastic, Reconstructive & Hand Surgery, Medisch Spectrum Twente, Enschede, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Moues
authors.affiliation: Department of Plastic, Reconstructive & Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: M B
authors.initials: MB
authors.lastname: Bouman
authors.affiliation: Department of Plastic, Reconstructive & Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: M G
authors.initials: MG
authors.lastname: Mullender
mesh_terms: D062088:Acellular Dermis; D018427:Breast Implants; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Acellular dermal matrix; Breast reconstruction; Implant based reconstruction; Single-stage breast reconstruction; Strattice