Comparing the Outcome of Different Biologically Derived Acellular Dermal Matrices in Implant-based Immediate Breast Reconstruction: A Meta-analysis of the Literatures

Abstract

Background:Acellular dermal matrices (ADMs) have been used extensively in implant-based breast reconstruction. It was reported that due to the different sources and processing methods, the outcomes of ADMs in implant-based breast reconstructions are expected to differ. We designed this study to statistically analyze and discuss the outcome of 3 commonly used ADMs, Alloderm, Strattice, and Surgimend in implant-based breast reconstruction.Methods:Comprehensive review of the literatures searched on electronic databases was done to identify studies published between 2006 and 2017 comparing the outcome of ADMs. Pooled random effect estimates for each complication and 95% confidence interval (CI) were calculated. One-way analysis of variance and Bonferroni test were used to compare statistical significance between and within groups, respectively. Multiple linear regression was done to include confounding factors and R statistic program for forest plot.Results:Twenty-one studies met the inclusion with a total of 1,659, 999, and 912 breasts reconstructions in Alloderm, Strattice, and Surgimend, respectively. Seven complications extracted including major and minor infection, seroma, implant loss, hematoma, capsular contracture, and localized erythema. Pooled total complication rates were 23.82% (95% CI, 21.18–26.47%) in Strattice, 17.98% (95% CI, 15.49–20.47%) in Surgimend, 16.21% (95% CI, 14.44–17.99%) in Alloderm. Seroma rate was the highest in Strattice group (8.61%; 95% CI, 6.87–10.35%). There was no statistical significance between and within groups.Conclusion:Although Strattice exhibited a higher overall pooled complication rate compared with Alloderm and Surgimend, the incidence of individual complication varies between studies. A cost analysis of different ADMs may aid in choosing the type of ADMs to be used.

Complication Rate of Prepectoral Implant-based Breast Reconstruction Using Human Acellular Dermal Matrices

“…Since then, several authors have published their series of 2-stage or DTI prepectoral IBRs using bovine, porcine, or human ADMs. 15 , 20 , 42 In truth, prepectoral IBR can be performed with or without ADMs but different authors have assessed that complication rate and, in particular, the capsular contracture rates are significantly lower when prepectoral IBR is performed with an ADM support. 12 , 43 , 44 …”

“…In the last 10 years, many reports concerning the incidence of complications related to ADMs have been published. 20 – 23 The aim of this article is to provide an update of the complication rates of immediate and delayed prepectoral IBR using human ADMs (hADMs).…”

Comparison of 30-day Clinical Outcomes with SimpliDerm and AlloDerm RTU in Immediate Breast Reconstruction

“…One recent meta-analysis of ADM-assisted breast reconstructions identified rates of ADM explantation for any reason ranging from 1.3%–23.8%. 30 However, the small size of this case series suggests that the true rate of explantation and any associated risk factors will remain uncertain until greater patient experience is obtained.…”

The Use of Absorbable Mesh in Implant-Based Breast Reconstruction: A 7-Year Review

“…The disadvantages include increased incidence of seroma; lack of sterility (acellular dermal matrices are aseptic rather than sterile); and exposure to antibiotics within packaging of acellular dermal matrix, which may result in allergic reaction, increased incidence of infection, and high cost. 12 – 15…”