254 Establishing Equipoise: Does the Use of Acellular Dermal Matrices (ADM) in Women Undergoing Pre-Pectoral Implant-Based Breast Reconstruction Increase Operative Success Versus Non-Use of ADM in the Same Setting?

Abstract Aim Breast cancer is the most common malignancy among females in the UK. Surgical management commonly comprises mastectomy and reconstruction, of which implant-based breast reconstruction (IBBR) are most prevalent. Acellular dermal matrices (ADM) are widely used in pre-pectoral implant-based breast reconstruction, however there is limited high-quality evidence supporting their efficacy. This study aims to establish equipoise via an expert consensus survey. Method An online survey was designed with a steering group of experts. Questions covered participant information, opinions regarding surgical outcomes with ADM use in pre-pectoral IBBR and opinions regarding available scientific evidence on the topic. The survey was advertised via national and international professional organisations. Quantitative and qualitative analyses were performed. Results Thirty-two participants from the UK, Italy and Australia completed the survey. Breast and plastic surgeons from consultant to registrar grade participated. Participants who believed that ADM reduced the risk of short-term complications and implant failure/explantation comprised a minority – 21.9%. Participants who felt that ADM use improved cosmetic outcomes and reduced long-term complications made up a relative majority – 34.4% and 40.6%, respectively. 56.3% of participants felt there was scarce scientific evidence on the topic. Conclusions This study provides international expert insight into the lack of consensus on surgical outcomes, efficacy and evidence-base supporting the use of ADMs in pre-pectoral IBBR. Given the growing burden of breast-cancer associated morbidity and the need for reconstruction, this study highlights the requirement for large-scale, prospective, randomised-controlled data to support decisions surrounding use of ADMs in pre-pectoral IBBR.