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.

Several different surgical methods have been described with good results, minimal scars, and various levels of complications. Traditional surgical excision of glandular tissue combined with liposuction provides most consistent results and a low rate of complications. Pubertal gynecomastia may safely be managed by pharmacological anti-oestrogen treatment.

Women who suffer from breast hypertrophy commonly have physical symptoms such as back pain and psychosocial problems. Breast reduction surgery is performed to relieve these problems. Side-effects must be kept to a minimum. Risk factors for developing postoperative complications have not clearly been identified so far. The aim of this study was to identify risk factors that lead to complications. The medical records of 512 consecutive women (mean age 40 years) who underwent bilateral breast reduction were retrospectively studied. All complications that occurred during the first 30 days after the operation were retrieved from medical records. Complications occurred in 32% of the patients within 30 days of surgery. The most common complication was infection at the surgical site (16%) followed by delayed wound healing (10%). Fat necrosis occurred in 2.5%, partial areola necrosis in 3.1%, and total areola necrosis in 0.6% of the patients. A longer suprasternal notch to nipple distance gave significantly higher risk of postoperative infection (p < 0.001) and necrosis in the mammilla (p < 0.001). The resected specimen weight during the operation was found to significantly influence the risk of delayed wound healing (p = 0.021) and fat necrosis (p < 0.001). Smokers had twice the risk of getting a postoperative infection, RR = 2.0 (95% CI = 1.3-3.1). Diabetics had a significantly higher risk of necrosis of the areola (p = 0.003). All the above predictors were identified as independent predictors. Complications after breast reduction are common. The study has identified several risk factors for complications, some of them independent, which might be avoidable by performing a careful preoperative evaluation of the patient.