title: A systematic review and meta-analysis of complications associated with acellular dermal matrix-assisted breast reconstruction.
abstract: BACKGROUND
  Multiple outcome studies have been published on the use of acellular dermal matrix (ADM) in breast reconstruction with disparate results. The purpose of this study was to conduct a systematic review and meta-analysis to determine an aggregate estimate of risks associated with ADM-assisted breast reconstruction.
  
  
  METHODS
  The MEDLINE, Web of Science, and Cochrane Library databases were queried, and relevant articles published up to September 2010 were analyzed based on specific inclusion criteria. Seven complications were studied including seroma, cellulitis, infection, hematoma, skin flap necrosis, capsular contracture, and reconstructive failure. A pooled random effects estimate for each complication and 95% confidence intervals (CI) were derived. For comparisons of ADM and non-ADM, the pooled random effects odds ratio (OR) and 95% CI were derived. Heterogeneity was measured using the I2 statistic.
  
  
  RESULTS
  Sixteen studies met the inclusion criteria. The pooled complication rates were seroma (6.9%; 95% CI, 5.3%-8.8%), cellulitis (2.0%; 95% CI, 1.2%-3.1%), infection (5.7%; 95% CI, 4.3%-7.3%), skin flap necrosis (10.9%; 95% CI, 8.7%-13.5%), hematoma (1.3%; 95% CI, 0.6%-2.4%), capsular contracture (0.6%; 95% CI, 0.1%-1.7%), and reconstructive failure (5.1%; 95% CI, 3.8%-6.7%). Five studies reported findings for both the ADM and non-ADM patients and were used in the meta-analysis to calculate pooled OR. ADM-assisted breast reconstructions had a higher likelihood of seroma (pooled OR, 3.9; 95% CI, 2.4-6.2), infection (pooled OR, 2.7; 95% CI, 1.1-6.4), and reconstructive failure (pooled OR, 3.0; 95% CI, 1.3-6.8) than breast reconstructions without the use of ADM. The relation of ADM use to hematoma (pooled OR, 2.0; 95% CI, 0.8-5.2), cellulitis (pooled OR, 2.0; 95% CI, 0.9-4.3), and skin flap necrosis (pooled OR, 1.9; 95% CI, 0.6-5.4) was inconclusive.
  
  
  CONCLUSIONS
  In the studies evaluated, ADM-assisted breast reconstructions exhibited a higher likelihood of seroma, infection, and reconstructive failure than prosthetic-based breast reconstructions using traditional musculofascial flaps. ADM is associated with a lower rate of capsular contracture. A careful risk/benefit analysis should be performed when choosing to use ADM in implant-based breast reconstruction.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, USA.
authors.forename: Goretti
authors.initials: G
authors.lastname: Ho
authors.forename: T JoAnna
authors.initials: TJ
authors.lastname: Nguyen
authors.forename: Ahva
authors.initials: A
authors.lastname: Shahabi
authors.forename: Brian H
authors.initials: BH
authors.lastname: Hwang
authors.forename: Linda S
authors.initials: LS
authors.lastname: Chan
authors.forename: Alex K
authors.initials: AK
authors.lastname: Wong
mesh_terms: D000328:Adult; D000368:Aged; D018427:Breast Implants / Q000009:adverse effects; D002481:Cellulitis / Q000453:epidemiology / Q000209:etiology; D003286:Contracture / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006084:Graft Rejection; D006406:Hematoma / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000473:pathology; D011379:Prognosis; D018570:Risk Assessment; D049291:Seroma / Q000453:epidemiology / Q000209:etiology; D016038:Skin Transplantation / Q000009:adverse effects* / Q000379:methods; D017768:Skin, Artificial / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000473:pathology; D015626:Tissue Expansion / Q000379:methods; D014481:United States