A Meta-analysis of Postoperative Complications of Tissue Expander/Implant Breast Reconstruction Using Acellular Dermal Matrix

Zhao, Xin; Wu, Xiaowei; Dong, Jie; Liu, Yingying; Zheng, Liang; Zhang, Liming

doi:10.1007/s00266-015-0555-z

Cited by 67 publications

(32 citation statements)

References 23 publications

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“…29 However, our study suggests that there is no difference in complications between the 2 groups; however, our sample size is relatively small, and definitive conclusions cannot be made. In theory, autologous tissue should be less immunogenic and more compatible, suggesting perhaps that there should be a lower complication especially with regard to infection rates.…”

Section: Discussionmentioning

confidence: 59%

Acellular Dermal Matrix Versus Inferior Deepithelialized Flap Breast Reconstruction: Equivalent Outcomes, with Increased Cost

Hon

Mubang

Wernick

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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Background:Approximately 250,000 new cases of breast cancer are diagnosed yearly in the U.S. resulting in more postmastectomy breast reconstructions (PMBRs). The acellular dermal matrix (ADM) expander-implant method became popular in the mid-2000s, but newer techniques such as the inferior deepithelialized flap (IDF) has more recently been described. We hypothesize that ADMs and IDFs provide comparable aesthetic outcomes, with no difference in complication rates and operative characteristics.Methods:A retrospective, single-institution study was performed between July 1, 2012, and June 30, 2014, examining all PMBR’s (ADM and IDF). Outcomes were categorized as clinical (e.g., complications requiring surgical intervention) or aesthetic.Results:A total of 65 patients (41 ADM; 24 IDF; mean age, 53.4 ± 10.7 years) were included, with 101 PMBR’s evaluated (63 ADM and 38 IDF). Patients who underwent IDFs had higher body mass index (32 versus 25; P < 0.01) and higher grades of breast ptosis. Major complication rates were similar between ADM and IDF groups (22% versus 31.5%; P = 0.34). There were no differences in aesthetic outcomes between groups (rater intraclass correlation, 0.92). The average IDF breast reconstruction took nearly 30 minutes longer per reconstructed side (192 minutes versus 166 minutes; P = 0.02), but operative costs were more expensive for the ADM breast reconstruction.Conclusions:The IDF procedure took 30 minutes longer for each reconstructed side, without significant differences in complications or aesthetic outcomes between the 2 PMBRs. IDF reconstructions may be more suitable for patients with grade 3 breast ptosis and higher body mass index. Further studies should focus on long-term outcomes and value-based approaches to PMBR.

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Section: Discussionmentioning

confidence: 59%

Acellular Dermal Matrix Versus Inferior Deepithelialized Flap Breast Reconstruction: Equivalent Outcomes, with Increased Cost

Hon

Mubang

Wernick

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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“…They found that incorporation of ADMs increased the incidence of overall complications (odds ratio [OR]: 1.33 compared with control), hematoma/seroma formation (OR: 1.66), and infection (OR: 1.47). 40 Exact rate of seroma formation following ADM use was then quantified in 2010, with rates of 14.1 versus 2.7% reported when comparing ADM to non-ADM breast reconstruction, respectively. 26 Similarly, the same study showed the rates of infection after ADM use to be 8.9 versus 2.1% for those patients who did not receive ADM. 26 However, in 2011, a separate retrospective review of 331 patients reported only a 1.5% seroma rate and a 3.0% infection rate following immediate single-stage implant reconstructions with ADM. 41 An additional 2011 study of 470 total patients reported a 6.9% overall wound infection rate in the ADM cohort compared with 2.5% in the non-ADM cohort, but the difference was not statistically significant.…”

Section: Disadvantages Of Acellular Dermal Matrix Usementioning

confidence: 99%

Evidence for the Use of Acellular Dermal Matrix in Implant-Based Breast Reconstruction

Gravina

Pettit

Davis

et al. 2019

Seminars in Plastic Surgery

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Acellular dermal matrices (ADMs) are tissue grafts that have been specially processed to remove all cellular components. These machined biological scaffolds have become popular in a variety of surgical settings due to their rapid incorporation into living tissue. As ADMs are highly malleable and cause minimal inflammation, they have come to serve as a useful tool in implant-based breast reconstruction procedures. The major benefits of using an ADM in this setting include superior initial breast contouring, decreased risk of capsular contracture after implant insertion, and consistent sustained positioning of the reconstructed breast. Despite these advantages, these tissue grafts are foreign to the host, and postoperative complications following ADM insertion, including infection and seroma, have been well documented. When considering using ADMs in this setting, it is important to first consider patient-specific factors that could preclude their use, such as low body mass index, small breasts, or a history of radiation exposure to the breast tissue. ADM grafts are also expensive, which may present another barrier to their use. Review of the literature ultimately suggests a continued role for ADMs in implant-based breast reconstruction, and continued research in this field is warranted.

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“…The risk of complications, including SSI, is affected by the type of breast surgery and whether breast reconstruction is performed. Current surgical options include breast-saving techniques, mastectomy, autograft techniques, use of an acellular dermal matrix, implantation of breast implants, and a combination of these methods [4,[5][6][7]. SSI occurs in an average of 2-7% of patients who undergo breast surgery.…”

Section: Discussionmentioning

confidence: 99%

Surgical Site Infection after Breast Surgery: Retrospective Analysis of 5-year Postoperative Data from a Single Center in Poland

Pałubicka¹,

Jaworski²,

Wekwejt³

et al. 2019

Preprint

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Purpose: Surgical site infection (SSI) is a significant complication of non-reconstructive and reconstructive breast. This study aimed to assess SSI after breast surgery over 5 years in a single center in Poland. The microorganisms responsible for SSI and their antibiotic susceptibility were determined. Materials/methods: Data of 2129 patients acquired over 5 years postoperatively by the [center] were analyzed. Results: SSI was diagnosed in 132 patients (6.2%) and was an early infection in most cases (65.2%). The incidence of SSI was highest in patients who underwent subcutaneous amputation with simultaneous reconstruction using an artificial prosthesis (14.6%) and breast reconstruction via the TRAM flap method (14.3%). Gram-positive bacteria were responsible for SSI in most cases (72.1%), and these were mainly Staphylococcus strains (53.6%). These strains were 100% susceptible to all beta-lactam antibiotics (except penicillin), but were less susceptible to macrolides and lincosamides. Conclusions: SSI is a serious problem, and attention should be focused on its prevention. Reconstruction using an artificial prosthesis or via the TRAM flap method is connected to increased SSI incidence. Further studies are required to prevent SSI following breast surgery.

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A Meta-analysis of Postoperative Complications of Tissue Expander/Implant Breast Reconstruction Using Acellular Dermal Matrix

Cited by 67 publications

References 23 publications

Acellular Dermal Matrix Versus Inferior Deepithelialized Flap Breast Reconstruction: Equivalent Outcomes, with Increased Cost

Acellular Dermal Matrix Versus Inferior Deepithelialized Flap Breast Reconstruction: Equivalent Outcomes, with Increased Cost

Evidence for the Use of Acellular Dermal Matrix in Implant-Based Breast Reconstruction

Surgical Site Infection after Breast Surgery: Retrospective Analysis of 5-year Postoperative Data from a Single Center in Poland

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