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A Meta-Analysis of Human Acellular Dermis and Submuscular Tissue Expander Breast Reconstruction

Kim, John Y. S. M.D.; Davila, Armando A. B.S.; Persing, Scott B.A., M.P.H.; Connor, Caitlin M. B.A.; Jovanovic, Borko Ph.D.; Khan, Seema A. M.D.; Fine, Neil M.D.; Rawlani, Vinay M.D.

Plastic and Reconstructive Surgery: January 2012 - Volume 129 - Issue 1 - p 28–41
doi: 10.1097/PRS.0b013e3182361fd6
Breast: Outcomes Article

Background: Human acellular dermal matrix has become an increasingly used adjunct to traditional submuscular tissue expander/implant breast reconstruction, but there is no strong consensus regarding complication outcomes. This study stratified outcomes based on a meta-analysis of complications.

Methods: A query of the MEDLINE database for articles on human acellular dermal matrix and submuscular tissue expander breast reconstruction yielded 901 citations. Two levels of screening identified 48 relevant studies. The DerSimonian and Laird random-effects model was used to perform the meta-analysis. Risk ratios and pooled complication rates were calculated for each outcome of interest.

Results: Nineteen studies reporting human acellular dermal matrix (n = 2037) and 35 reporting submuscular outcomes (n = 12,847) were used to estimate complication rates. Rates were generally higher in acellular dermis patients: total complications, 15.4 versus 14.0 percent; seroma, 4.8 versus 3.5 percent; infection, 5.3 versus 4.7 percent; and flap necrosis, 6.9 versus 4.9 percent. Six studies reporting both acellular dermis and submuscular outcomes were used to estimate relative risks. There was an increased risk of total complications (relative risk, 2.05; 95 percent CI, 1.55 to 2.70), seroma (relative risk, 2.73; 95 percent CI, 1.67 to 4.46), infection (relative risk, 2.47; 95 percent CI, 1.71 to 3.57), and reconstructive failure (relative risk, 2.80; 95 percent CI, 1.76 to 4.45) in acellular dermis patients.

Conclusions: The meta-analysis suggests that the use of human acellular dermal matrix increases complication rates vis-à-vis submuscular expander/implant reconstruction. This must be weighed against its reported advantages in enhancing cosmesis and ameliorating contracture.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Chicago and Maywood, Ill.

From the Division of Plastic and Reconstructive Surgery, the Department of Preventative Medicine, and the Lynn Sage Breast Center, Northwestern University, Feinberg School of Medicine, and Loyola University Chicago, Stritch School of Medicine.

Received for publication March 21, 2011; accepted June 16, 2011.

Disclosure: Dr. Kim is a consultant for and receives research funding from Mentor and the Musculoskeletal Transplant Foundation. Dr. Fine receives research funding from Allergan, Inc. The remaining authors have no financial relationships to disclose.

John Y. S. Kim, M.D.; Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, 675 North St. Clair Street, Galter Suite 19-250, Chicago, Ill. 60611, jokim@nmh.org

©2012American Society of Plastic Surgeons