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

DeLong, Michael R. M.D.1; Tandon, Vickram J. M.D.2; Farajzadeh, Matthew B.S.1; Berlin, Nicholas L. M.D., M.P.H.2; MacEachern, Mark P. M.L.I.S.3; Rudkin, George H. M.D.1; Da Lio, Andrew L. M.D.1; Cederna, Paul S. M.D2

Plastic and Reconstructive Surgery: August 23, 2019 - Volume PRS Online First - Issue - p
doi: 10.1097/PRS.0000000000006212
Original Article: PDF Only

Introduction: Acellular Dermal Matrix (ADM) is used in most post-mastectomy implant-based breast reconstructions in the United States. It is believed to be safe, despite a slightly increased complication rate. Though never established in a unifying study, the primary advantage of ADM 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 ADM in expander-to-implant breast reconstruction.

Methods: A systematic review adhering to Preferred Reporting Items for Systematic Review (PRISMA) methodology was performed including all original studies examining aesthetic outcomes of expander-to-implant breast reconstructions with ADM 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 manuscripts were reviewed and nine manuscripts ultimately met inclusion criteria. All nine studies were not randomized. Of these, three manuscripts (1448 total patients) evaluated reconstruction aesthetic outcomes by patient satisfaction while six manuscripts evaluated the aesthetic outcomes by external observer (504 total patients). None of the manuscripts evaluating patient satisfaction reported a difference between ADM and muscular reconstruction. Five of the six manuscripts using objective outcomes demonstrated significant improvement in aesthetic outcome in the ADM group.

Conclusions: Though little evidence exists evaluating the aesthetic benefits of ADM for expander-to-implant breast reconstruction, the data suggest that objective observers consider ADM-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.

1. Division of Plastic Surgery, Department of Surgery, University of California at Los Angeles, Los Angeles, CA 90095

2. Section of Plastic Surgery, University of Michigan, Ann Arbor, MI 48109

3. Taubman Health Sciences Library, University of Michigan School of Medicine, Ann Arbor, MI 48109

This project has been accepted for presentation at ASPS Chicago 2018

Financial Disclosure Statement: The authors report no financial conflicts of interest. This study was not funded.

Corresponding author: Paul Cederna, M.D., Chief, Section of Plastic Surgery, Robert Oneal Professor of Plastic Surgery, Professor, Department of Biomedical Engineering, 2130 Taubman Center, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-0340, Telephone: (734) 936-5885, Fax: (734) 763-5354

©2019American Society of Plastic Surgeons