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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

Hallberg, Håkan; Rafnsdottir, Svanheidur; Selvaggi, Gennaro; Strandell, Annika; Samuelsson, Ola; Stadig, Ida; Svanberg, Therese; Hansson, Emma LU and Lewin, Richard (2018) In Journal of Plastic Surgery and Hand Surgery2010-01-01+01:00
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... (More)

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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author
publishing date
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Contribution to journal
publication status
epub
keywords
Journal Article
in
Journal of Plastic Surgery and Hand Surgery2010-01-01+01:00
pages
18 pages
publisher
Taylor & Francis
ISSN
2000-656X
DOI
10.1080/2000656X.2017.1419141
language
English
LU publication?
no
id
098c1f44-c977-4b4e-aae3-daffea19ed41
date added to LUP
2018-01-14 22:10:16
date last changed
2018-01-15 08:31:26
@article{098c1f44-c977-4b4e-aae3-daffea19ed41,
  abstract     = {<p>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.</p>},
  author       = {Hallberg, Håkan and Rafnsdottir, Svanheidur and Selvaggi, Gennaro and Strandell, Annika and Samuelsson, Ola and Stadig, Ida and Svanberg, Therese and Hansson, Emma and Lewin, Richard},
  issn         = {2000-656X},
  keyword      = {Journal Article},
  language     = {eng},
  month        = {01},
  pages        = {18},
  publisher    = {Taylor & Francis},
  series       = {Journal of Plastic Surgery and Hand Surgery2010-01-01+01:00},
  title        = {Benefits and risks with acellular dermal matrix (ADM) and mesh support in immediate breast reconstruction : a systematic review and meta-analysis},
  url          = {http://dx.doi.org/10.1080/2000656X.2017.1419141},
  year         = {2018},
}