Updated Evidence of Acellular Dermal Matrix Use for Implant-Based Breast Reconstruction: A Meta-analysis

Lee, Kyeong‐Tae; Mun, Goo‐Hyun

doi:10.1245/s10434-015-4873-9

Cited by 126 publications

(86 citation statements)

References 51 publications

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“…Baker grade III/IV CC was seen in 1.2% of cases. Several factors may have contributed to the low rates of CC including the utilization of anatomic gel implants 37 and the use ADM 38–40 and mesh, 7,41 which are associated with decreased incidences of CC. Capsules around textured subcutaneous prostheses may also be thinner than those found with submuscular placement at short-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

Subcutaneous Implant-based Breast Reconstruction with Acellular Dermal Matrix/Mesh: A Systematic Review

Salibian

Frey

Choi

et al. 2016

Plastic and Reconstructive Surgery - Global Open

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Background:The availability of acellular dermal matrix (ADM) and synthetic mesh products has prompted plastic surgeons to revisit subcutaneous implant-based breast reconstruction. The literature is limited, however, with regards to evidence on patient selection, techniques, and outcomes.Methods:A systematic review of the Medline and Cochrane databases was performed for original studies reporting breast reconstruction with ADM or mesh, and subcutaneous implant placement. Studies were analyzed for level of evidence, inclusion/exclusion criteria for subcutaneous reconstruction, reconstruction characteristics, and outcomes.Results:Six studies (186 reconstructions) were identified for review. The majority of studies (66.7%) were level IV evidence case series. Eighty percent of studies had contraindications for subcutaneous reconstruction, most commonly preoperative radiation, high body mass index, and active smoking. Forty percent of studies commenting on patient selection assessed mastectomy flap perfusion for subcutaneous reconstruction. Forty-five percent of reconstructions were direct-to-implant, 33.3% 2-stage, and 21.5% single-stage adjustable implant, with ADM utilized in 60.2% of reconstructions versus mesh. Pooled complication rates included: major infection 1.2%, seroma 2.9%, hematoma 2.3%, full nipple-areola complex necrosis 1.1%, partial nipple-areola complex necrosis 4.5%, major flap necrosis 1.8%, wound healing complication 2.3%, explantation 4.1%, and grade III/IV capsular contracture 1.2%.Conclusions:Pooled short-term complication rates in subcutaneous alloplastic breast reconstruction with ADM or mesh are low in preliminary studies with selective patient populations, though techniques and outcomes are variable across studies. Larger comparative studies and better-defined selection criteria and outcomes reporting are needed to develop appropriate indications for performing subcutaneous implant-based reconstruction.

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Section: Discussionmentioning

confidence: 99%

Subcutaneous Implant-based Breast Reconstruction with Acellular Dermal Matrix/Mesh: A Systematic Review

Salibian

Frey

Choi

et al. 2016

Plastic and Reconstructive Surgery - Global Open

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“…Advocates of ADM in E/I reconstruction cite a number of purported benefits over traditional techniques, including the creation of aesthetically superior breast shapes by controlling implant position and improved tissue expansion dynamics, resulting in shorter expansion times and less patient discomfort (5–8). However, recent meta-analyses have reported greater risks of post-operative complications when ADM is used in E/I reconstruction, compared to total submuscular and dual plane techniques (9–11). These studies have noted higher rates of major infections, seromas and reconstructive failures with ADM.…”

Section: Introductionmentioning

confidence: 99%

Acellular Dermal Matrix in Immediate Expander/Implant Breast Reconstruction: A Multicenter Assessment of Risks and Benefits

Sorkin

Kim

et al. 2017

Plastic &Amp; Reconstructive Surgery

127

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INTRODUCTION Acellular dermal matrix (ADM) has gained widespread acceptance in immediate expander/implant reconstruction due to perceived benefits, including improved expansion dynamics and superior aesthetic results. Although previous investigators have evaluated its risks, few studies have assessed the impact of ADM on other outcomes, including patient-reported measures. METHODS The Mastectomy Reconstruction Outcomes Consortium (MROC) Study used a prospective cohort design to evaluate patients undergoing post-mastectomy reconstruction from 10 centers and 58 participating surgeons between 2012 and 2015. The analysis focused on women receiving immediate tissue expander reconstruction following mastectomies for cancer treatment or prophylaxis. Medical records and PRO data, using the BREAST-Q and Numeric Pain Rating Scale (NPRS) instruments, were reviewed. Bivariate analyses and mixed-effects regression models were applied. RESULTS A total of 1,297 patients were evaluated, including 655 (50.5%) with ADM and 642 (49.5%) without ADM. Controlling for demographic and clinical covariates, no significant differences were seen between ADM and non-ADM cohorts in overall complications (OR=1.21, p=0.263), major complications (OR=1.43, p=0.052), wound infections (OR=1.49, p=0.118), or reconstructive failures (OR=1.55, p=0.089) at two years following reconstruction. There were also no significant differences between the cohorts in the time to expander/implant exchange (p=0.78). No significant differences were observed in PRO scores, including satisfaction with breast, psychosocial well-being, sexual well-being, physical well-being and postoperative pain. CONCLUSION In our multicenter, prospective analysis, we found no significant ADM effects on complications, time to exchange or PRO in immediate expander/implant breast reconstruction. Further studies are needed to develop criteria for more selective use of ADM in these patients.

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“…However, the application of ADM has become one of the main options for implant-based breast reconstruction (16). ADM has many benefits over the traditional submuscular technique.…”

Section: Discussionmentioning

confidence: 99%

“…ADM has many benefits over the traditional submuscular technique. These include, enhanced lower pole expansion, easier definition of the inframammary fold (IMF), a reduction in postoperative pain, and improved cosmetic outcomes (5, 6, 15, 16). Thus, its use in breast reconstruction has become increasingly popular.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonography Findings of AlloDerm® Used in Postmastectomy Alloplastic Breast Reconstruction: A Case Report and Literature Review

Kim

2016

Iran J Radiol

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AlloDerm® (LifeCell Corp.; Brancburg, NJ) is an acellular dermal matrix (ADM) that serves as an immunologically inert scaffold in plastic surgery. In breast reconstruction, it is used as a filler for lumpectomy defects and can be used to create the inferolateral portion of the tissue expander pocket or implant pocket in postmastectomy patients. However, there are limited reports of the radiologic findings of AlloDerm® in patients who have undergone postmastectomy reconstruction. Familiarity with the imaging features of AlloDerm® is essential for correct diagnosis. We report the ultrasonography features of AlloDerm® in a 43-year-old female patient 3 months after postmastectomy reconstruction. It may help distinguish AlloDerm® from tumor recurrence or other foreign body materials such as gossypiboma. This is important as misdiagnosis can often lead to unnecessary surgical intervention.

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Updated Evidence of Acellular Dermal Matrix Use for Implant-Based Breast Reconstruction: A Meta-analysis

Cited by 126 publications

References 51 publications

Subcutaneous Implant-based Breast Reconstruction with Acellular Dermal Matrix/Mesh: A Systematic Review

Subcutaneous Implant-based Breast Reconstruction with Acellular Dermal Matrix/Mesh: A Systematic Review

Acellular Dermal Matrix in Immediate Expander/Implant Breast Reconstruction: A Multicenter Assessment of Risks and Benefits

Ultrasonography Findings of AlloDerm® Used in Postmastectomy Alloplastic Breast Reconstruction: A Case Report and Literature Review

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