by
DeLong, Michael R.; Tandon, Vickram J.; Farajzadeh, Matthew; Berlin, Nicholas
L.; MacEachern, Mark P.; Rudkin, George H.; Da Lio, Andrew L.; Cederna, Paul S
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.
