Efficacy of Acellular Dermal Matrix in Capsular Contracture of Implant-Based Breast Reconstruction: A Single-Arm Meta-analysis.

Abstract

BACKGROUND:

A large number of clinical studies have suggested that acellular dermal matrix (ADM) can decrease the incidence of capsular contracture in implant-based breast reconstruction. Yet, there is currently no high-level epidemiological evidence to prove this. The goal of this meta-analysis was to clarify the efficacy of ADM in capsular contracture, and provide a reference value for plastic surgeons.

METHODS:

We systematically performed a search on PubMed, EMBASE, and the Cochrane Library to identify eligible studies from inception up to October 1, 2019. A random-effects model was used to obtain a pooled incidence rate. We conducted subgroup analysis according to geographic region, type of ADM, body mass index (BMI), duration of follow-up, and proportion of participants who have received radiotherapy.

RESULTS:

A total of 18 studies involving 2941 cases were included. Overall, the pooled incidence rate of capsular contracture was 2.4% (95% CI 1.2-3.9%). The results from subgroup analyses indicated an even lower incidence in North America (1.6%, 95% CI 0.5-3.3%) and in human-derived ADM (HADM) (1.2%, 95% CI 0.2-3.0%). In addition, the results showed that the patients with BMI < 24, or who have received radiotherapy, were more prone to capsular contracture.

CONCLUSION:

The application of ADM can effectively reduce the incidence of capsular contracture in implant-based breast reconstruction. And we infer that it might also apply to breast augmentation. However, additional high-quality trials are warranted to corroborate the findings of this meta-analysis.

LEVEL OF EVIDENCE III:

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

• Authors: Jian Liu, Jinfei Hou, Zhipeng Li, Bin Wang, Jiaming Sun
• Journal: Aesthetic plastic surgery (Aesthetic Plast Surg) Vol. 44 Issue 3 Pg. 735-742 (06 2020) ISSN: 1432-5241 [Electronic] United States
• PMID: 31919627 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't)

Topics

• Acellular Dermis
• Breast Implantation (adverse effects)
• Breast Implants (adverse effects)
• Contracture
• Follow-Up Studies
• Humans
• Implant Capsular Contracture (epidemiology, etiology, prevention & control)
• Mammaplasty (adverse effects)