A Systematic Review and Meta-Analysis of Complications Associated With Acellular Dermal Matrix-Assisted Breast Reconstruction
Top Cited Papers
- 1 April 2012
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Annals of Plastic Surgery
- Vol. 68 (4), 346-356
- https://doi.org/10.1097/sap.0b013e31823f3cd9
Abstract
Background: Multiple outcome studies have been published on the use of acellular dermal matrix (ADM) in breast reconstruction with disparate results. The purpose of this study was to conduct a systematic review and meta-analysis to determine an aggregate estimate of risks associated with ADM-assisted breast reconstruction. Methods: The MEDLINE, Web of Science, and Cochrane Library databases were queried, and relevant articles published up to September 2010 were analyzed based on specific inclusion criteria. Seven complications were studied including seroma, cellulitis, infection, hematoma, skin flap necrosis, capsular contracture, and reconstructive failure. A pooled random effects estimate for each complication and 95% confidence intervals (CI) were derived. For comparisons of ADM and non-ADM, the pooled random effects odds ratio (OR) and 95% CI were derived. Heterogeneity was measured using the I-2 statistic. Results: Sixteen studies met the inclusion criteria. The pooled complication rates were seroma (6.9%; 95% CI, 5.3%-8.8%), cellulitis (2.0%; 95% CI, 1.2%-3.1%), infection (5.7%; 95% CI, 4.3%-7.3%), skin flap necrosis (10.9%; 95% CI, 8.7%-13.5%), hematoma (1.3%; 95% CI, 0.6%-2.4%), capsular contracture (0.6%; 95% CI, 0.1%-1.7%), and reconstructive failure (5.1%; 95% CI, 3.8%-6.7%). Five studies reported findings for both the ADM and non-ADM patients and were used in the meta-analysis to calculate pooled OR. ADM-assisted breast reconstructions had a higher likelihood of seroma (pooled OR, 3.9; 95% CI, 2.4-6.2), infection (pooled OR, 2.7; 95% CI, 1.1-6.4), and reconstructive failure (pooled OR, 3.0; 95% CI, 1.3-6.8) than breast reconstructions without the use of ADM. The relation of ADM use to hematoma (pooled OR, 2.0; 95% CI, 0.8-5.2), cellulitis (pooled OR, 2.0; 95% CI, 0.9-4.3), and skin flap necrosis (pooled OR, 1.9; 95% CI, 0.6-5.4) was inconclusive. Conclusions: In the studies evaluated, ADM-assisted breast reconstructions exhibited a higher likelihood of seroma, infection, and reconstructive failure than prosthetic-based breast reconstructions using traditional musculofascial flaps. ADM is associated with a lower rate of capsular contracture. A careful risk/benefit analysis should be performed when choosing to use ADM in implant-based breast reconstruction.Keywords
This publication has 41 references indexed in Scilit:
- Techniques to Reduce Seroma and Infection in Acellular Dermis–Assisted Prosthetic Breast ReconstructionPlastic and Reconstructive Surgery, 2010
- The Effect of Acellular Dermal Matrix Use on Complication Rates in Tissue Expander/Implant Breast ReconstructionAnnals of Plastic Surgery, 2010
- Implant-Based Breast Reconstruction Using Acellular Dermal Matrix and the Risk of Postoperative ComplicationsPlastic and Reconstructive Surgery, 2010
- Expander/Implant Reconstruction with AlloDerm: Recent ExperiencePlastic and Reconstructive Surgery, 2009
- Immediate Single-Stage Breast Reconstruction Using Implants and Human Acellular Dermal Tissue Matrix With Adjustment of the Lower Pole of the Breast to Reduce Unwanted LiftAnnals of Plastic Surgery, 2008
- A Single Surgeon???s 12-Year Experience with Tissue Expander/Implant Breast Reconstruction: Part I. A Prospective Analysis of Early ComplicationsPlastic and Reconstructive Surgery, 2006
- Measuring inconsistency in meta-analysesBMJ, 2003
- Infectious Complications following Breast Reconstruction with Expanders and ImplantsPlastic and Reconstructive Surgery, 2003
- Infection Following Breast ReconstructionAnnals of Plastic Surgery, 1989
- Meta-analysis in clinical trialsControlled Clinical Trials, 1986