Systematic Review of the Impact of Acellular Dermal Matrix on Aesthetics and Patient Satisfaction in Tissue Expander-to-Implant Breast Reconstructions

Abstract

Background: Acellular dermal matrix is used in most postmastectomy implant-based breast reconstructions in the United States. It is believed to be safe, despite a slightly increased complication rate. Although never established in a unifying study, the primary advantage of acellular dermal matrix is believed to be an enhanced aesthetic result, thus justifying the added expense. The purpose of this study was to assess the aesthetic benefits of acellular dermal matrix in expander-to-implant breast reconstruction. Methods: A systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology was performed including all original studies examining aesthetic outcomes of expander-to-implant breast reconstructions with acellular dermal matrix compared to muscular coverage. Direct-to-implant and prepectoral studies were excluded from the evaluation. The results were aggregated and reported as a summary. Results: Among 883 studies identified, 49 full-text articles were reviewed and nine articles ultimately met inclusion criteria. All nine studies were not randomized. Of these, three articles (1448 total patients) evaluated reconstruction aesthetic outcomes by patient satisfaction, whereas six articles evaluated the aesthetic outcomes by external observer (504 total patients). None of the articles evaluating patient satisfaction reported a difference between acellular dermal matrix and muscular reconstruction. Five of the six articles using objective outcomes demonstrated significant improvement in aesthetic outcome in the acellular dermal matrix group. Conclusions: Although little evidence exists evaluating the aesthetic benefits of acellular dermal matrix for expander-to-implant breast reconstruction, the data suggest that objective observers consider acellular dermal matrix–assisted expander-to-implant breast reconstructions aesthetically superior to reconstruction with only muscular coverage, but patients appear to be equally satisfied with both reconstructive options.

A Randomized Controlled Trial Comparing Alloderm-RTU with DermACELL in Immediate Subpectoral Implant-Based Breast Reconstruction

“…The primary outcome of the study was seroma formation and drain duration. Seromas following prosthetic based breast reconstruction are common and can be associated with infection and prosthetic loss due to conditions created such as a hypovascular, proinflammatory milieu of the mastectomy skin flap, a geometrically complex dead space, and the presence of a foreign body with potential contamination and biofilm [ 17 , 18 , 19 , 20 ]. Higher drainage volume also leads to a longer duration of drains and disrupts the postoperative life of the patient [ 20 , 21 ].…”

“…Seromas following prosthetic based breast reconstruction are common and can be associated with infection and prosthetic loss due to conditions created such as a hypovascular, proinflammatory milieu of the mastectomy skin flap, a geometrically complex dead space, and the presence of a foreign body with potential contamination and biofilm [ 17 , 18 , 19 , 20 ]. Higher drainage volume also leads to a longer duration of drains and disrupts the postoperative life of the patient [ 20 , 21 ]. The use of a drain itself poses the risk of open communication with skin and external flora, allowing for direct colonization of the wound site and greatly increased the risk of wound infection and possible failure [ 19 , 21 ].…”

“…This study aims to evaluate postsurgical outcomes with the use of Alloderm-RTU compared to DermACELL in immediate subpectoral implant-based breast reconstruction. The primary outcome is seroma formation, as prolonged seroma is the most common complication following implant-based breast reconstruction using ADMs [ 17 , 18 , 19 , 20 ]. Prolonged seroma formation can progress to infection and prosthesis loss [ 20 , 21 ].…”

“…The primary outcome is seroma formation, as prolonged seroma is the most common complication following implant-based breast reconstruction using ADMs [ 17 , 18 , 19 , 20 ]. Prolonged seroma formation can progress to infection and prosthesis loss [ 20 , 21 ]. It may also interfere with the process of integration and thereby the success of the reconstruction [ 13 , 20 , 21 ].…”

“…Prolonged seroma formation can progress to infection and prosthesis loss [ 20 , 21 ]. It may also interfere with the process of integration and thereby the success of the reconstruction [ 13 , 20 , 21 ]. In addition, time to drain removal, while often overlooked by surgeons, is a common complaint about patients, as it can result in postoperative discomfort or pain and increased office visits [ 20 , 21 ].…”