A Meta-analysis of Postoperative Complications of Tissue Expander/Implant Breast Reconstruction Using Acellular Dermal Matrix
- 611 Downloads
Acellular dermal matrix (ADM) is commonly used for tissue expander/implant breast (TE/I-based) reconstruction. But the relation between ADM and postoperative complications remains controversial. A few meta-analyses were conducted in 2011–2012 and the result revealed that ADM can increase the risk of complications. The purpose of our study is to offer updated evidence for ADM clinical application by analyzing the effect of ADM on complications of TE/I-based breast reconstruction.
The literature published from January 2010 to February 2015 was searched in EMbase, Medline, Science Direct, the Cochrane Central Register of Controlled Trials (CENTRAL), CBMdisc, CNKI, VIP, and the references of those included studies were also searched by hand. According to inclusive criteria, 11 studies were selected and the values were extracted from the included literature. Complications with four different categories assigned for overall complications, infection, hematoma/seroma, and explantation were collected. RevMan 5.1 was used for meta-analysis. The evidence level was assessed by using the GRADE system.
Eleven published studies were included. The results showed that compared to the control group, the ADM group increased the rate of overall complications (OR = 1.33, 95 % CI 1.03–1.70, p = 0.03), infection (OR = 1.47, 95 % CI 1.04–2.06, p = 0.03), hematoma/seroma (OR = 1.66, 95 % CI 1.13–2.44, p = 0.01), but there was no significant difference in explantation (OR = 1.37, 95 % CI 0.89–2.11, p = 0.15). Based on the GRADE system, all the evidence was at level C and weak recommendation.
In TE/I-based breast reconstruction, ADM increased the incidence of overall complications, infection, and hematoma/seroma; the incidence of explantation remains unknown. For the poor quality of the original studies, a prudent choice is suggested; and more high-quality, large-sample studies are needed.
No Level Assigned
This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266.
KeywordsBreast reconstruction Acellular dermal matrix Meta-analysis
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest to disclose.
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- 8.Peled AW, Foster RD, Garwood ER, Moore DH, Ewing CA, Alvarado M, Hwang ES, Esserman LJ (2012) The effects of acellular dermal matrix in expander-implant breast reconstruction after total skin-sparing mastectomy: results of a prospective practice improvement study. Plast Reconstr Surg 129(6):901e–908eCrossRefPubMedGoogle Scholar
- 12.Nguyen MD, Chen C, Colakoğlu S, Morris DJ, Tobias AM, Lee BT (2010) Infectious complications leading to explantation in implant-based breast reconstruction with AlloDerm. Eplasty 10:404–411Google Scholar
- 17.Becker S, Saint-Cyr M, Wong C, Dauwe P, Nagarkar P, Thornton JF, Peng Y (2009) AlloDerm VerSUS DermaMatrix in immediate expander-based breast reconstruction: preliminary comparison of complication profiles and material compliance. Plast Reconstr Surg 123(1):1–6 discussion 107-8 CrossRefPubMedGoogle Scholar
- 18.Higgins JPT, Green S (eds) (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated Macch 2011]. The cochrane collaboration. Available from http://www.cochrane.handbook.org
- 19.Brozek J, Oxman A, Schünemann H. (2008) GRADEpro [computer program]. Version 3.2 for Windows http://ims.cochrane.org/revman/gradepro
- 20.LifeCell (2011) AlloDerm tissue matrix defined, vol. 2011Google Scholar
- 21.Wu XW, Jian QC, Dong YL, Long DC (2011) Dual plane penile augmentation with human acellular dermal matrix through penile lengthening incision. Chin J Med Aesth Cosmet 17(5):336–339Google Scholar