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

Journal article
Authors Håkan Hallberg
Svanheidur Rafnsdottir
Gennaro Selvaggi
Annika Strandell
Ola Samuelsson
Ida Stadig
Therese Svanberg
Emma Hansson
Richard Lewin
Published in Journal of Plastic Surgery and Hand Surgery
Volume 52
Issue 3
Pages 130-147
ISSN 2000-656X
Publication year 2018
Published at Institute of Clinical Sciences, Department of Plastic Surgery
Institute of Clinical Sciences
Pages 130-147
Language en
Links https://doi.org/10.1080/2000656X.20...
Keywords aceullar dermal matrix, ADM, Breast reconstruction, implant, matrix, mesh, systematic review, tissue expander
Subject categories Plastic surgery

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.

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