Patient-reported Outcomes After ADM-assisted Implant-based Breast Reconstruction

A Cross-Sectional Study

Vera L. Negenborn, MD; Rieky E. G. Dikmans, MD; Mark-Bram Bouman, PhD; Janneke A. Wilschut, PhD; Margriet G. Mullender, PhD; C. Andrew Salzberg, MD


Plast Reconstr Surg Glob Open. 2018;6(2):e1654 

In This Article

Abstract and Introduction


Background: Although the use of acellular dermal matrices (ADMs) in implant-based reconstruction increases, there is a lack of studies evaluating patient-reported outcome measures after this reconstruction method. We aim to evaluate the patient satisfaction after ADM-assisted implant-based breast reconstruction (IBBR) in 1 of the largest series of patients undergoing ADM-assisted IBBR.

Methods: Patients with ADM-assisted IBBR were invited to fill out the BREAST-Q, a validated and standardized questionnaire to measure patient satisfaction after a breast reconstruction. A retrospective chart review was performed to identify patient and surgical characteristics.

Results: In total, 208 patients (38.4%) responded and reported a mean satisfaction of 70.6 ± 20.2 with their breasts and 78.0 ± 20.5 with the outcome. An overall complication rate of 7.7% was noted, with 1.5% severe complications leading to hospital readmission (0.5%) and implant removal (0.5%). Patients with complications and unilateral reconstruction for oncological reasons reported overall less satisfaction rates compared with patients with bilateral, preventive surgery, and an uncomplicated postoperative course. Strongly related domains indicate the importance of patient satisfaction with their breasts and outcome on psychosocial and sexual functioning and satisfaction with information on satisfaction with breasts, outcome, and surgeon.

Conclusion: There is an increased demand for patient-reported outcome measures in a changing practice to which the opinion of the patient assumes a larger role. With high satisfaction rates, ADM-assisted IBBR is a valuable reconstruction method, provided that complication rates remain low. Hence, it should only be performed in a selected group of women.


In high-income countries, survival rates of breast cancer patients have increased to 80% or higher.[1] Because incidence rates of breast cancer, especially in Western countries, are high and still rising, the number of breast cancer survivors is increasing rapidly. For this reason, focus of health care has shifted toward quality of life after cancer treatment. In most cases, breast surgery is required as part of cancer treatment, which entails either breast-conserving surgery or mastectomy. In women with an established high risk of breast cancer, mastectomy may also be performed prophylactically. In Western society, breast reconstruction has become an integral part of breast cancer treatment options. Breast reconstruction aims to approximate the "natural breast" as closely as possible with the ultimate goal to ameliorate the patients' quality of life.[2]

There are multiple techniques for breast reconstruction, of which implant-based breast reconstruction (IBBR) is the most performed reconstruction method.[3] In recent years, acellular dermal matrices (ADMs) are increasingly being used in IBBR to augment the subpectoral pocket and to allow immediate implantation of an implant or tissue expander.[4] Supposed additional advantages are a better cosmetic outcome,[4,5] and, in the long term, possible a reduced capsular contraction rate.[6]

Data regarding the safety of ADM use in IBBR vary widely, with complication rates ranging from below 5% to more than 50%.[4,7–9] Recent results indicate that expertise with both the technique and the careful selection of eligible patients are important factors for optimal clinical outcomes.[9,10] However, to assess to what extent the eventual goal of breast reconstructive surgery is reached, that is, to enhance the quality of life, measurement of patient-reported outcomes (PROs) is essential. Therefore, we aim to assess the satisfaction and quality of life of women who underwent ADM-assisted IBBR.

Previously, Salzberg et al.[6,11] reported on the clinical outcomes in 1 of the largest series of patients treated with ADM-assisted breast reconstruction. The overall complication rate was 8.6%, and the cumulative incidence of capsular contraction was low (0.8%).[8] In this study, we have evaluated the PROs of these women using the BREAST-Q, which is a validated tool developed specifically to assess satisfaction and quality of life after breast surgery.[12]