Complications, patient-reported outcomes, and aesthetic results in immediate breast reconstruction with a dermal sling : A systematic review and meta-analysis
(2019) In Journal of Plastic, Reconstructive and Aesthetic Surgery 72(3). p.369-380- Abstract
An inferior dermal flap (“sling”) can be used to cover an implant with two layers of tissue following Wise pattern skin-reducing mastectomies. Here, we performed a systematic review of the risks and benefits of this technique, specifically regarding complications, patient-reported outcomes, and aesthetic outcomes. PubMed and other relevant databases were searched using specific key words, with inclusion criteria comprising studies of dermal sling use involving ≥ 5 patients and performance according to the PICO framework. A meta-analysis was performed using a random-effects model involving a binomial distribution with logit-link function. For each study, the 95% confidence interval (CI) was obtained based on exact limits from a binomial... (More)
An inferior dermal flap (“sling”) can be used to cover an implant with two layers of tissue following Wise pattern skin-reducing mastectomies. Here, we performed a systematic review of the risks and benefits of this technique, specifically regarding complications, patient-reported outcomes, and aesthetic outcomes. PubMed and other relevant databases were searched using specific key words, with inclusion criteria comprising studies of dermal sling use involving ≥ 5 patients and performance according to the PICO framework. A meta-analysis was performed using a random-effects model involving a binomial distribution with logit-link function. For each study, the 95% confidence interval (CI) was obtained based on exact limits from a binomial distribution, and heterogeneity testing was performed using a chi-squared test. A total of 428 abstracts were retrieved, with 24 studies meeting the inclusion criteria and including a total of 879 patients and 1184 reconstructed breasts. The mean complication rate was 21.6% (95% CI: 16.9–27.2%), with the most common complication involving wound-healing problems (mean, 11.4%; 95% CI: 8.5–15.2%), and the frequency of implant loss (< 3 months) varied from 0% to 14% (mean, 2.2%; 95% CI: 1.1–4.4%). Seven articles reported patient-reported outcomes, and four reported aesthetic outcomes, with the quality of evidence classified as low for complications and very low for patient-reported outcomes and aesthetic outcomes. Our findings showed that although implant-based reconstruction with a dermal sling is widely used, there is little scientific evidence supporting the method.
(Less)
- author
- Jepsen, Christian ; Hallberg, Håkan ; Pivodic, Aldina ; Elander, Anna and Hansson, Emma LU
- organization
- publishing date
- 2019-01-08
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Complications, Dermal sling, Immediate breast reconstruction, Meta-analysis, Skin-reducing mastectomy
- in
- Journal of Plastic, Reconstructive and Aesthetic Surgery
- volume
- 72
- issue
- 3
- pages
- 369 - 380
- publisher
- Elsevier
- external identifiers
-
- pmid:30665838
- scopus:85060080256
- ISSN
- 1748-6815
- DOI
- 10.1016/j.bjps.2018.12.046
- language
- English
- LU publication?
- yes
- id
- b5a97407-7e52-4009-b5f6-aaacd6bf29bb
- date added to LUP
- 2019-01-30 08:36:05
- date last changed
- 2024-05-14 00:52:22
@article{b5a97407-7e52-4009-b5f6-aaacd6bf29bb,
abstract = {{<p>An inferior dermal flap (“sling”) can be used to cover an implant with two layers of tissue following Wise pattern skin-reducing mastectomies. Here, we performed a systematic review of the risks and benefits of this technique, specifically regarding complications, patient-reported outcomes, and aesthetic outcomes. PubMed and other relevant databases were searched using specific key words, with inclusion criteria comprising studies of dermal sling use involving ≥ 5 patients and performance according to the PICO framework. A meta-analysis was performed using a random-effects model involving a binomial distribution with logit-link function. For each study, the 95% confidence interval (CI) was obtained based on exact limits from a binomial distribution, and heterogeneity testing was performed using a chi-squared test. A total of 428 abstracts were retrieved, with 24 studies meeting the inclusion criteria and including a total of 879 patients and 1184 reconstructed breasts. The mean complication rate was 21.6% (95% CI: 16.9–27.2%), with the most common complication involving wound-healing problems (mean, 11.4%; 95% CI: 8.5–15.2%), and the frequency of implant loss (< 3 months) varied from 0% to 14% (mean, 2.2%; 95% CI: 1.1–4.4%). Seven articles reported patient-reported outcomes, and four reported aesthetic outcomes, with the quality of evidence classified as low for complications and very low for patient-reported outcomes and aesthetic outcomes. Our findings showed that although implant-based reconstruction with a dermal sling is widely used, there is little scientific evidence supporting the method.</p>}},
author = {{Jepsen, Christian and Hallberg, Håkan and Pivodic, Aldina and Elander, Anna and Hansson, Emma}},
issn = {{1748-6815}},
keywords = {{Complications; Dermal sling; Immediate breast reconstruction; Meta-analysis; Skin-reducing mastectomy}},
language = {{eng}},
month = {{01}},
number = {{3}},
pages = {{369--380}},
publisher = {{Elsevier}},
series = {{Journal of Plastic, Reconstructive and Aesthetic Surgery}},
title = {{Complications, patient-reported outcomes, and aesthetic results in immediate breast reconstruction with a dermal sling : A systematic review and meta-analysis}},
url = {{http://dx.doi.org/10.1016/j.bjps.2018.12.046}},
doi = {{10.1016/j.bjps.2018.12.046}},
volume = {{72}},
year = {{2019}},
}