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Published on: July 24, 2019
Outcomes of Acellular Dermal Matrix Use in Radiated Implant-based Breast Reconstruction: A Systematic Review and
Abdullah M Alhusain1,2, Abdulaziz M Alghamdi1,2, Muhannad Q Alqirnas3
1From the Department of Plastic and Reconstructive Surgery, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.
Background:
Acellular dermal matrix (ADM) has improved aesthetic and structural outcomes in implant-based postmastectomy breast reconstruction. However, outcomes in patients receiving postmastectomy radiotherapy (PMRT) remain inconsistent due to radiation-induced fibrosis and vascular compromise. This meta-analysis evaluates complication rates associated with ADM use in irradiated implant-based reconstruction.
Methods:
A PRISMA-guided search was conducted to identify studies reporting outcomes of ADM-assisted, irradiated postmastectomy breast reconstruction. Eligible studies were analyzed using proportional meta-analysis with subgroup comparisons based on ADM type, implant placement plane, and timing of radiotherapy.
Results:
Across all included studies, pooled complication rates were 16.8% for capsular contracture, 8.3% for infection, 5.8% for seroma, and 10.6% for implant loss. Implant plane significantly affected outcomes: prepectoral reconstruction demonstrated significantly lower rates of capsular contracture and infection compared with submuscular or mixed approaches, whereas mixed-plane placement was significantly associated with higher rates of implant malposition. Radiotherapy timing significantly influenced long-term outcomes: postoperative PMRT was associated with the highest rates of capsular contracture, implant loss, and reoperation, whereas preoperative PMRT demonstrated the lowest rates. ADM type also showed significant differences in capsular contracture, implant loss, and reoperation, with bovine matrices demonstrating significantly lower complication rates and porcine matrices showing favorable satisfaction outcomes. Overall patient satisfaction reached 80.8%.
Conclusions:
ADM-assisted implant reconstruction in irradiated patients is associated with variable complication rates influenced by ADM type, implant plane, and radiotherapy timing. Preoperative radiation and selected ADM materials, particularly bovine matrices, were associated with more favorable outcomes, whereas postoperative radiation was linked to higher long-term complication rates.