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Review: Implant-Based Breast Reconstruction After Mastectomy for Breast Cancer: A Meta-analysis of Randomized Controlled Trials and Prospective Studies Comparing Use of Acellular Dermal Matrix (ADM) Versus Without ADM

  • Reconstructive Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Breast cancer is the world’s most prevalent cancer, and many breast cancer patients undergo mastectomy as the choice of treatment, often with post-mastectomy breast reconstruction. Acellular dermal matrix (ADM) use has become a method to improve outcomes of reconstruction for these patients. We aimed to compare postoperative complications and patient-reported outcomes, which are still poorly characterized, between groups utilizing acellular dermal matrix during reconstruction and those without.

Materials and Methods

We searched electronic databases from inception to 16 June 2022 for randomized controlled trials and prospective cohort studies comparing the outcomes of patients who have and have not received acellular dermal matrix in implant-based breast reconstruction. The results were quantitatively combined and analyzed using random-effects models.

Results

A total of nine studies were included, representing 3161 breasts. There was no significant difference in postoperative outcomes, such as seroma formation (p = 0.51), hematomas (p = 0.20), infections (p = 0.21), wound dehiscence (p = 0.09), reoperations (p = 0.70), implant loss (p = 0.27), or skin necrosis (p = 0.21). Only two of the studies included evaluated patient-reported outcomes between the use and non-use of ADM in implant-based breast reconstruction using BREAST-Q questionnaire, as well as self-reported pain. There was no reported significant difference in BREAST-Q or pain scores.

Conclusions

This meta-analysis shows comparable short- and long-term outcomes between ADM and non-ADM breast reconstruction, suggesting that the use of ADM may not be necessary in all cases given their additional cost. However, there is a paucity of data for patient-reported outcomes, and further research is required to determine whether ADM use affects patient-reported outcomes.

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Author notes

  1. These authors share senior authorship: Clement Luck Khng Chia and Visnu Lohsiriwat.

Authors and Affiliations

  1. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Trina Priscilla Ng MBBS, Brandon Yong Kiat Loo MBBS, Nicole Yong MBBS & Clement Luck Khng Chia MBBS, FRCS (Ed)

  2. Breast Surgery Service, Department of Surgery, Khoo Teck Puat Hospital, Singapore, Singapore

    Trina Priscilla Ng MBBS, Brandon Yong Kiat Loo MBBS, Nicole Yong MBBS & Clement Luck Khng Chia MBBS, FRCS (Ed)

  3. Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Clement Luck Khng Chia MBBS, FRCS (Ed) & Visnu Lohsiriwat MD

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  1. Trina Priscilla Ng MBBS
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Correspondence to Clement Luck Khng Chia MBBS, FRCS (Ed).

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Ng, T.P., Loo, B.Y.K., Yong, N. et al. Review: Implant-Based Breast Reconstruction After Mastectomy for Breast Cancer: A Meta-analysis of Randomized Controlled Trials and Prospective Studies Comparing Use of Acellular Dermal Matrix (ADM) Versus Without ADM. Ann Surg Oncol 31, 3366–3376 (2024). https://doi.org/10.1245/s10434-024-14943-4

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