Acellular Dermal Matrices and Radiotherapy in Breast Reconstruction: A Systematic Review and Meta-Analysis of the Literature

Abstract

The increasing use of commercially available acellular dermis matrices for postmastectomy breast reconstruction seems to have simplified the surgical procedure and enhanced the outcome. These materials, generally considered to be highly safe or with only minor contraindications due to the necessary manipulation in preparatory phases, allow an easier one-phase surgical procedure, in comparison with autologous flaps, offering a high patient satisfaction. Unfortunately, the claim for a higher rate of complications associated with irradiation at the implant site, especially when the radiation therapy was given before the reconstructive surgery, suggested a careful behaviour when this technique is preferred. However, this hypothesis was never submitted to a crucial test, and data supporting it are often discordant or incomplete. To provide a comprehensive analysis of the field, we searched and systematically reviewed papers published after year 2005 and registered clinical trials. On the basis of a meta-analysis of data, we conclude that the negative effect of the radiotherapy on the breast reconstruction seems to be evident even in the case of acellular dermis matrices aided surgery. However, more trials are needed to make solid conclusions and clarify the poor comprehension of all the factors negatively influencing outcome.

Porcine acellular dermis-based breast reconstruction: complications and outcomes following adjuvant radiotherapy

“…In a very recent study by Barber et al [ 7 ], the reconstruction loss rate was quoted to be as high as 47.6 %. Current general opinion is that radiation is a risk for higher rate of ADM complications as such there is a bias in terms of amount of information available regarding this [ 17 ]. With the emergence of data suggesting the protective effect of ADM, it is necessary to identify the consequence of timing of radiation in ADM reconstruction [ 8 ].…”

International multidisciplinary expert panel consensus on breast reconstruction and radiotherapy

“…Mesh‐assisted implant‐based breast reconstruction using acellular dermal matrix (ADM) is controversial, with conflicting data in the setting of PMRT. Two recent meta‐analyses reported twofold to threefold higher risks of surgical complications in women undergoing ADM‐implant breast reconstruction combined with radiotherapy. There is a paucity of evidence on the impact of PMRT on prepectoral ADM‐implant reconstruction, with evidence to date comprising small retrospective case series with short‐term follow‐up.…”

“…Sigalove and colleagues reported a case series of 33 patients (52 reconstructions) over 25 months, with similar conclusions. The US practice of two‐stage mesh‐assisted implant breast reconstruction differs significantly from that in Europe, where most mesh‐assisted implant reconstructions are single‐stage procedures and utilize either biological or synthetic meshes. There is an urgent need to obtain prospective clinical data on outcomes from different anatomical locations of the implant (subpectoral or prepectoral) in mesh‐assisted implant reconstructions in the radiotherapy setting.…”

Scarring vs. functional healing: Matrix-based strategies to regulate tissue repair

“…Alloderm ® has been shown to increase skin flexibility and improve scar quality in full-thickness wounds [143] while Oasis ® has facilitated complete healing in 60% of patients with chronic leg ulcers compared to 35% with the standard treatment [144]. Various decellularized dermis mesh materials are increasingly used in breast reconstructive procedures [145, 146], and Alloderm ® has also been used to facilitate frozen-banked ovarian tissue transplantation in the first reported pregnancies and live birth using this technique [147]. Decellularized tissues are commercially available in cardiac applications for the repair of heart valves (e.g., SynerGraft ® ) and pericardium (e.g., CorMatrix ® ECM).…”