Back to 2011 Posters
A SYSTEMATIC REVIEW AND META-ANALYSIS OF COMPLICATIONS ASSOCIATED WITH ADM-ASSISTED BREAST RECONSTRUCTION
Goretti Ho, MD, T. JoAnna Nguyen, MD, Ahva Shahabi, MPH, Brian H. Hwang, MD, Alex K. Wong, MD.
Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
Background: The use of acellular dermal matrix (ADM) has increased in implant-based breast reconstruction. Multiple studies have been published to evaluate the outcomes of the use of ADM in breast reconstruction, with no consensus in regard to the rate of complications associated with its use. The purpose of this study is to conduct a systematic review to address the rate of complications with the use of ADM by pooling power from all of the available studies to date.
Methods: The initial keyword-generated literature search on English-language articles using MEDLINE, Web of Science, Cochrane Library and manual search up to July 2010 yielded 61 citations. Two levels of screening identified 17 relevant studies. Seven outcome rates were analyzed: seroma, cellulitis, infection, hematoma, skin flap necrosis, capsular contracture and reconstructive failure. Six studies with both ADM and non-ADM treatment groups were used for the meta-analysis. A random effects model with 95% confidence intervals was used to evaluate statistical heterogeneity among the studies. Heterogeneity was measured using the p values and the I2 statistic.
Results: Seventeen studies with relevant data on the treatment and outcomes of interest met the inclusion criteria. Six studies reporting both the ADM and non-ADM outcomes were used in the meta-analysis to calculate the estimated pooled relative risks of the following complications: seroma, cellulitis, infection, and hematoma. Statistical heterogeneity is evident only for infection. ADM-assisted breast reconstructions were found to be 3.4 times as likely to experience a seroma (relative risk, 3.42; 95% CI, 2.24-5.23); twice as likely to be complicated by cellulitis (relative risk, 2.13; 95% CI, 1.14-3.97) and hematoma (relative risk 2.04; 95% CI, 0.82-5.07); and 2.5 times as likely to become infected (relative risk 2.45; 95% CI, 1.1-5.46). Seventeen studies reporting ADM-assisted breast reconstruction outcomes were used to estimate pooled complication rates. The results for the common complications are as follows: seroma (6.9%; 95% CI, 5.36-8.77); cellulitis (2.1%; 95%CI, 1.30-0.32); infection (5.65%; 95%CI, 4.29-7.31); skin flap necrosis (10.9%; 95%CI, 8.71-13.52); hematoma (1.34%; 95%CI, 0.67-2.41); capsular contracture (0.58%; 95%CI, 0.12-1.72).
Conclusion: This analysis suggests that ADM-assisted breast reconstructions exhibit a higher rate of complications when compared to the traditional technique using musculofascial flaps.
Back to 2011 Posters