One of the things that we recognise in South Africa is that we have a population who are keen to have reconstruction and both in government and in private we’re keen to offer reconstruction to every woman who wants it. An excellent method of breast reconstruction in early stage cancer is a bilateral skin-sparing mastectomy and immediate direct implant reconstruction. But one of the questions we had was whether or not we needed to use an acellular dermal matrix. Now, that is a piece of equipment which is a collagen structure which reinforces the reconstruction. We found in our series not using it of more than 250 women that we had the same outcomes as the series who were using it; we had the same or actually less complication rates and, most excitingly, we managed to save the money so it became more cost efficient because we were saving this pretty expensive piece of equipment which actually doubled the cost of the reconstruction.
Now, that has implications in the private sector because it’s important for us to save our medical aids as much money as possible because that means that they will continue to support reconstruction. But it’s critical in the public sector where breast prostheses can be relatively economical to use but the acellular dermal matrix priced the reconstruction out the market. So now we can tell our government sector patients that either if they can afford the smaller cost of a prosthesis or if we can find donations of those we can give them an excellent reconstruction equivalent to what they should get in any international centre.
How were you measuring outcomes?
We were looking at complication rates, both within one year and later on than that. The main complications were infection and seroma formation. It’s a wise question and the next stage of the study has to look at cosmetic outcomes in two to five years to ensure that there is no drop or other substandard cosmetic outcome. But the main reason that one uses an acellular dermal matrix is to prevent those other complications.