Benefits and risks with acellular dermal matrix (ADM) and mesh support in immediate breast reconstruction: a systematic review and meta-analysis

Research output: Contribution to journalReview article

Abstract

In modern implant-based immediate breast reconstruction, it has become common to use biological acellular dermal and synthetic matrices in combination with a tissue expander or an implant. The aim of this systematic review was to examine differences in recurrence of cancer, impact on oncological treatment, health related quality of life, complications and aesthetic outcome between matrix and no matrix in immediate breast reconstruction. Systematic searches, data extraction and assessment of methodological quality were performed according to predetermined criteria. Fifty-one studies were eligible and included in the review. The certainty of evidence for overall complication rate and implant loss is low (GRADE ⊕⊕□ □). The certainty of evidence for delay of adjuvant treatment, implant loss, infection, capsular contraction and aesthetic outcome is very low (GRADE ⊕□ □ □). No study reported data on recurrence of cancer or health related quality of life. In conclusion, there is a lack of high quality studies that compare the use of matrix with no matrix in immediate breast reconstruction. Specifically, there are no data on risk of recurrence of cancer, delay of adjuvant treatment and Health related quality of life (HRQoL). In addition, there is a risk of bias in many studies. It is often unclear what complications have been included and how they have been diagnosed, and how and when capsular contracture and aesthetic outcome have been evaluated. Controlled trials that further analyse the impact of radiotherapy, type of matrix and type of procedure (one or two stages) are necessary.

Details

Authors
  • Håkan Hallberg
  • Svanheidur Rafnsdottir
  • Gennaro Selvaggi
  • Annika Strandell
  • Ola Samuelsson
  • Ida Stadig
  • Therese Svanberg
  • Emma Hansson
  • Richard Lewin
External organisations
  • Sahlgrenska University Hospital
  • University of Gothenburg
Research areas and keywords

Keywords

  • Journal Article
Original languageEnglish
Number of pages18
JournalJournal of Plastic Surgery and Hand Surgery
Publication statusE-pub ahead of print - 2018 Jan 10
Publication categoryResearch
Peer-reviewedYes
Externally publishedYes