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Immediate Breast Cancer Reconstruction with or without Dermal Matrix or Synthetic Mesh Support: A Review and Network
Donal Murphy1, John P O'Donnell1, Éanna J Ryan1
1From the Department of Surgery, Galway University Hospitals.
Plastic and Reconstructive Surgery
|February 2, 2023
Summary
Traditional breast reconstruction without acellular dermal matrices (ADMs) or synthetic mesh showed fewer complications than human ADM (HADM). Xenograft ADM (XADM) and synthetic mesh had similar outcomes to no ADM/mesh, suggesting careful material selection for implant-based breast reconstruction (IBBR).
Area of Science:
- Plastic Surgery
- Biomaterials Science
- Surgical Oncology
Background:
- Implant-based breast reconstruction (IBBR) commonly utilizes acellular dermal matrices (ADMs) and synthetic mesh.
- This study compares the clinical efficacy and safety of human ADM (HADM), xenograft ADM (XADM), and synthetic mesh in postmastectomy patients against traditional submuscular pocket techniques.
Approach:
- A systematic network meta-analysis was conducted on randomized controlled trials and observational studies.
- Thirty-one studies were included to evaluate complications, implant loss, infection, and seroma rates for different IBBR methods.
Key Points:
- Traditional submuscular placement (no ADM or mesh) had fewer overall complications than HADM.
- No significant differences in overall complications were found between no ADM/mesh and XADM or synthetic mesh.
- HADM was associated with higher rates of infectious complications and seroma compared to no ADM/mesh.
Conclusions:
- The choice of IBBR material should balance effectiveness, adverse events, and cost.
- HADM demonstrated a higher predisposition to infection and seroma, warranting careful consideration.
- Further randomized trials are needed to compare XADM and synthetic meshes due to similar risk profiles and cost differences.
