Complication rates of acellular dermal matrix in immediate breast reconstruction with radiation: A single-institution retrospective comparison study

Stein, Michael J.; Chung, Amy M.; Arnaout, Angel; Ghaedi, Bahareh; Ghumman, Ammara; Zhang, Tinghua; Zhang, Jing

doi:10.1016/j.bjps.2020.05.065

Cited by 11 publications

(24 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In Eriksson 2013, all patients received partial submuscular implants; other studies did not report the anatomic plane of implant placement. In Stein 2020, the mean size of the implants ranged from 406 to 444 cc; other studies did not report implant sizes. None of the studies reported additional information about the implants, such as surface (smooth versus textured) or shape (round versus tear drop).…”

Section: Overall Summary For Key Questionmentioning

confidence: 99%

“…Three NRCSs (Hirsch 2014, Stein 2020, andYoon 2020) reported data for a heterogeneous group of composite or unspecified harms, each of which was comparable between groups of women receiving IBR before or after radiation therapy. These included any complication, major complications, major complications needing hospitalization or surgery, operative complications, nonoperative complications, and minor complications.…”

Section: Surgical Complicationsmentioning

confidence: 99%

See 1 more Smart Citation

Breast Reconstruction After Mastectomy: A Systematic Review and Meta-Analysis

Saldanha¹,

Cao²,

Broyles³

et al. 2021

View full text Add to dashboard Cite

Objectives. This systematic review evaluates breast reconstruction options for women after mastectomy for breast cancer (or breast cancer prophylaxis). We addressed six Key Questions (KQs): (1) implant-based reconstruction (IBR) versus autologous reconstruction (AR), (2) timing of IBR and AR in relation to chemotherapy and radiation therapy, (3) comparisons of implant materials, (4) comparisons of anatomic planes for IBR, (5) use versus nonuse of human acellular dermal matrices (ADMs) during IBR, and (6) comparisons of AR flap types. Data sources and review methods. We searched Medline®, Embase®, Cochrane CENTRAL, CINAHL®, and ClinicalTrials.gov from inception to March 23, 2021, to identify comparative and single group studies. We extracted study data into the Systematic Review Data Repository Plus (SRDR+). We assessed the risk of bias and evaluated the strength of evidence (SoE) using standard methods. The protocol was registered in PROSPERO (registration number CRD42020193183). Results. We found 8 randomized controlled trials, 83 nonrandomized comparative studies, and 69 single group studies. Risk of bias was moderate to high for most studies. KQ1: Compared with IBR, AR is probably associated with clinically better patient satisfaction with breasts and sexual well-being but comparable general quality of life and psychosocial well-being (moderate SoE, all outcomes). AR probably poses a greater risk of deep vein thrombosis or pulmonary embolism (moderate SoE), but IBR probably poses a greater risk of reconstructive failure in the long term (1.5 to 4 years) (moderate SoE) and may pose a greater risk of breast seroma (low SoE). KQ 2: Conducting IBR either before or after radiation therapy may result in comparable physical well-being, psychosocial well-being, sexual well-being, and patient satisfaction with breasts (all low SoE), and probably results in comparable risks of implant failure/loss or need for explant surgery (moderate SoE). We found no evidence addressing timing of IBR or AR in relation to chemotherapy or timing of AR in relation to radiation therapy. KQ 3: Silicone and saline implants may result in clinically comparable patient satisfaction with breasts (low SoE). There is insufficient evidence regarding double lumen implants. KQ 4: Whether the implant is placed in the prepectoral or total submuscular plane may not be associated with risk of infections that are not explicitly implant related (low SoE). There is insufficient evidence addressing the comparisons between prepectoral and partial submuscular and between partial and total submuscular planes. KQ 5: The evidence is inconsistent regarding whether human ADM use during IBR impacts physical well-being, psychosocial well-being, or satisfaction with breasts. However, ADM use probably increases the risk of implant failure/loss or need for explant surgery (moderate SoE) and may increase the risk of infections not explicitly implant related (low SoE). Whether or not ADM is used probably is associated with comparable risks of seroma and unplanned repeat surgeries for revision (moderate SoE for both), and possibly necrosis (low SoE). KQ 6: AR with either transverse rectus abdominis (TRAM) or deep inferior epigastric perforator (DIEP) flaps may result in comparable patient satisfaction with breasts (low SoE), but TRAM flaps probably increase the risk of harms to the area of flap harvest (moderate SoE). AR with either DIEP or latissimus dorsi flaps may result in comparable patient satisfaction with breasts (low SoE), but there is insufficient evidence regarding thromboembolic events and no evidence regarding other surgical complications. Conclusion. Evidence regarding surgical breast reconstruction options is largely insufficient or of only low or moderate SoE. New high-quality research is needed, especially for timing of IBR and AR in relation to chemotherapy and radiation therapy, for comparisons of implant materials, and for comparisons of anatomic planes of implant placement.

show abstract

Section: Overall Summary For Key Questionmentioning

confidence: 99%

Section: Surgical Complicationsmentioning

confidence: 99%

Breast Reconstruction After Mastectomy: A Systematic Review and Meta-Analysis

Saldanha¹,

Cao²,

Broyles³

et al. 2021

View full text Add to dashboard Cite

show abstract

“…No eligible studies evaluated timing relative to of chemotherapy. Five NRCSs, reported in 10 articles, 21,23,26,44,45,[47][48][49]52,56 and no RCTs evaluated timing relative to radiation in 2834 patients (between 130 and 1143 patients each) (Table 1). Four NRCSs were at a high and one at a moderate risk of bias.…”

Section: Timing Relative To Chemotherapy and Radiationmentioning

confidence: 99%

Implant-based Breast Reconstruction after Mastectomy for Breast Cancer: A Systematic Review and Meta-analysis

Saldanha

Broyles

Adam

et al. 2022

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

More than 40% of US women who undergo mastectomy for breast cancer have breast reconstruction, 1 amounting to about 107,000 women in 2019. 2 Most reconstruction procedures in the United States (81%) are implant-based. 2 Considerations for implant-based reconstruction (IBR) include procedure timing relative to chemotherapy and radiation, implant material (eg, silicone, saline, doublelumen), anatomic plane (prepectoral, partial submuscular, or total submuscular), and use of an adjunctive human acellular dermal matrix (ADM). Each consideration can impact aesthetics, complications, and cost. ObjectivesWe conducted a systematic review (SR) for the Agency for Healthcare Research and Quality (AHRQ) to support the American Society of Plastic Surgeons in development of a new clinical practice guideline on breast reconstruction after mastectomy. 3 Here, we focus on the research

show abstract

“…7,8 Few studies have evaluated long-term complications and outcomes with ADMs in IBBR. 9,10 Published studies with short follow-up periods of about 2 years or less suggest the use of ADMs may be associated with lower rates of capsular contracture but possibly higher rates of seroma, infection, and skin flap necrosis. 9,[11][12][13] However, these results have not been confirmed by observations over longer periods.…”

Section: Introductionmentioning

confidence: 99%

Acellular Dermal Matrices in Breast Reconstruction: CARE Trial 5-Year Outcomes Data for More Than 9500 Patients

Ellsworth

Hammer

et al. 2022

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

Background: Few studies have assessed long-term complications in women undergoing implant-based breast reconstruction with use of an acellular dermal matrix (ADM). This study compared outcomes over 5 years in women undergoing breast reconstruction procedures with and without ADM. Methods: Complications data in patients enrolled in the prospective Continued Access Reconstruction/Revision Expansion trial were segregated by use of ADM versus no ADM in patients undergoing primary breast reconstruction or revision-reconstruction. Continued Access Reconstruction/Revision Expansion trial evaluated long-term safety and effectiveness of shaped, textured, silicone implants. Results: Of the 9502 women, 257 had primary (n = 160) or revision-reconstruction ( n = 97) with ADMs; 9245 had primary (n = 6977) or revision-reconstruction ( n = 2268) without ADMs. Capsular contracture rates in primary reconstruction were lower with ADM than without at year 5 (3.2% versus 7.4%); rates were similar at year 1 (≤2.4%). Capsular contracture rates in revision-reconstruction were lower with ADM than without at year 5 (1.4% versus 8.9%); rates were similar at year 1 (≤2.5%). Seroma rates were low and sustained for all cohorts throughout the 5 years (≤2.9%). Reoperation rates increased over time in all cohorts, with similar rates between groups (2.4%–47.3% from week 4 to year 5 across cohorts). Other trends over time included lower rates for asymmetry and implant malposition with ADM than without. Conclusion: These long-term data suggest that the use of ADM in breast reconstruction procedures may provide a benefit in reducing complications, such as capsular contracture, and may sustain low rates of seroma.

show abstract

Complication rates of acellular dermal matrix in immediate breast reconstruction with radiation: A single-institution retrospective comparison study

Cited by 11 publications

References 27 publications

Breast Reconstruction After Mastectomy: A Systematic Review and Meta-Analysis

Breast Reconstruction After Mastectomy: A Systematic Review and Meta-Analysis

Implant-based Breast Reconstruction after Mastectomy for Breast Cancer: A Systematic Review and Meta-analysis

Acellular Dermal Matrices in Breast Reconstruction: CARE Trial 5-Year Outcomes Data for More Than 9500 Patients

Contact Info

Product

Resources

About