Efficacy of Acellular Dermal Matrix in Capsular Contracture of Implant-Based Breast Reconstruction: A Single-Arm Meta-analysis

  • Jian Liu
  • Jinfei Hou
  • Zhipeng Li
  • Bin Wang
  • Jiaming SunEmail author
Original Article Breast Surgery



A large number of clinical studies have suggested that acellular dermal matrix (ADM) can decrease the incidence of capsular contracture in implant-based breast reconstruction. Yet, there is currently no high-level epidemiological evidence to prove this. The goal of this meta-analysis was to clarify the efficacy of ADM in capsular contracture, and provide a reference value for plastic surgeons.


We systematically performed a search on PubMed, EMBASE, and the Cochrane Library to identify eligible studies from inception up to October 1, 2019. A random-effects model was used to obtain a pooled incidence rate. We conducted subgroup analysis according to geographic region, type of ADM, body mass index (BMI), duration of follow-up, and proportion of participants who have received radiotherapy.


A total of 18 studies involving 2941 cases were included. Overall, the pooled incidence rate of capsular contracture was 2.4% (95% CI 1.2–3.9%). The results from subgroup analyses indicated an even lower incidence in North America (1.6%, 95% CI 0.5–3.3%) and in human-derived ADM (HADM) (1.2%, 95% CI 0.2–3.0%). In addition, the results showed that the patients with BMI < 24, or who have received radiotherapy, were more prone to capsular contracture.


The application of ADM can effectively reduce the incidence of capsular contracture in implant-based breast reconstruction. And we infer that it might also apply to breast augmentation. However, additional high-quality trials are warranted to corroborate the findings of this meta-analysis.

Level of Evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors


Acellular dermal matrix Capsular contracture Breast reconstruction Meta-analysis 



This study was funded by the National Key R&D Program of China (2019YFA0110500) and the National Natural Science Foundation of China (Nos. 81873941 and 81701922).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical Approval

All analyses were based on previous published studies, and thus, ethical approval is unnecessary.

Informed Consent

This study was based on previous published studies, so informed consent was unnecessary.


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© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2020

Authors and Affiliations

  1. 1.Department of Plastic Surgery, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina

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