Assessment of the Interi Manifold in Implant-Based Breast Reconstruction

Stanford University20 enrolled

Overview

Patients with breast cancer that elect to undergo implant-based breast reconstruction (IBBR) often require the placement of a surgical drain. Surgical drains are used to manage dead space and prevent seroma formation or accumulation of fluid within the surgical field postoperatively. The most frequently used drain is a Jackson-Pratt (JP) drain, which is limited by poor surgical site coverage and low capacity, leading to inconsistent suction and prolonged time that a drain is left in place. The Interi Drain system is a novel, multi-branched manifold with a proprietary suction system that provides consistent suction and addresses many of the shortcoming of JP drains. The purpose of this study is to compare the Interi system to standard JP drains across outcomes including number of surgical drain sites, complication rates, time to drain removal, time to initiate tissue expansion, total fluid volume drained, and patient satisfaction.

Patients seeking a mastectomy with immediate tissue expander/implant-based breast reconstruction will be considered. Potential participants will be screened for inclusion and exclusion criteria and informed of the study protocols, risk, and potential benefits. Consenting patients who meet eligibility criteria will undergo bilateral mastectomy and immediate, implant-based breast reconstruction using a tissue expander. On the day of surgery, patient breasts will be randomized into the Interi cohort or the JP cohort, such that in each patient one breast receives the Interi drain and the other receives JP drains. Randomization will be stratified by the laterality of the primary tumor. The respective drains will be placed intraoperatively. Postoperative care will proceed as standard. Postoperative follow-up will occur within 1 week of surgery. Weekly follow-ups with documentation of clinical data throughout recovery will also take place until removal of the drain systems, which typically occurs 1-3 weeks after surgery. While drains are in place, patients will be required to monitor drain output and keep a daily drain log. Thereafter, follow-ups will be scheduled as needed (monthly) according to the usual clinical practice of implant-based breast reconstruction. This will include routine tissue expansion in preparation for the second stage expander to definitive implant exchange.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Interventions

Interi Manifold Drain SystemDEVICE

The Interi manifold surgical drain system will be placed in the breast pocket during stage 1 immediate implant based breast reconstruction. Output of the interi drain will be monitored daily and the Interi drain will remain in the surgical site until criteria for drain removal are met. Removal of the Interi drain will be performed in clinic by surgical staff.

Jackson Pratt Drain SystemDEVICE

The Jackson Pratt surgical drain system will be placed in the breast pocket during stage 1 immediate implant based breast reconstruction. Output of the Jackson Pratt drain will be monitored daily and the drain will remain in the surgical site until criteria for drain removal are met. Removal of the Jackson Pratt drain will be performed in clinic by surgical staff.

Eligibility

Sex: FEMALEMin age: 18 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Breast cancer diagnosis (any form) or Genetic mutation with presence of breast mass. 2. Indication for bilateral mastectomy 3. Plan for immediate, implant-based pre-pectoral breast reconstruction using an acellular dermal matrix 4. Age 18 - 65 5. Female Sex 6. Ability to understand and the willingness to personally sign the written IRB-approved informed consent document (English language). Exclusion Criteria: 1. Have a prior history of radiation to the breast or planned radiotherapy to the breast within the first year post-operatively. 2. Are enrolled in another study that requires the concomitant use of any investigational product during the study period that the Principal Investigator believes will interfere with study endpoints. 3. Have received oncologic chemotherapy within the past 21 days or planned within the time fame of the study intervention. Have received antiplatelet therapy (other than aspirin) and/ or other anticoagulation therapy in the past 60 days. 4. Are a smoker or use illicit drugs. 5. Any prior allergic reaction to Teflon. 6. Are pregnant or nursing. 7. Are undergoing a delayed reconstruction following mastectomy. 8. HIV infection, active UTI infection, or other active infection. 9. Those requiring more than one Manifold for fluid removal per breast will be excluded.

Outcomes

Primary Outcomes

Device safety

Incidence of adverse events or complications (e.g. seroma, hematoma, infection, dehiscence, etc.) will be recorded for both drain systems.

Time frame: Complications will be recorded until stage 2 surgery (replacement of tissue expanders with permanent implants), which typically occurs after 6 months.

Time to drain removal

The number of days between placement of each drain system (stage 1 surgery) and removal of the drain (defined as 2 consecutive days with drain output below 30 mL).

Time frame: Drain removal typically occurs between 1-3 weeks post-op.

Secondary Outcomes

Number of drain sites

The number of drain sites (holes exiting the surgical site) in each breast.

Time frame: This will be recorded by the surgeon immediately after completion of the stage 1 operation.

Total fluid drained

The amount of fluid (mL) collected by each surgical drain from the operative breast for the duration of drain placement will be recorded for both drain systems.

Time frame: Drain removal typically occurs between 1-3 weeks post-op.

Time to initiate tissue expansion

The amount of time in days after tissue expander placement (same operative time point as drain placement) for a patient to begin tissue expansion (when determined clinically appropriate by the attending physician).

Time frame: Tissue expansion typically begins 3-6 weeks after stage 1 surgery.

Patient satisfaction (BreastQ)

Both quality of life and patient satisfaction will be assessed by validated patient survey (BreastQ). Each breast will be assessed independently by the patient to determine if the type of drain has affected the patient's perception of their recovery.

Time frame: Administration of BreastQ will occur at specific post-operative time points (e.g. 1 week, 3 weeks, 6 months, and 1 year).

Patient satisfaction (study-specific survey)

Patient satisfaction with each drain system and ease of use will be assessed using a study-specific survey.

Time frame: Administration of the study specific survey will occur at specific post-operative time points (e.g. 1 week, 2 weeks, and at drain removal).