title: Acellular dermal matrix in irradiated tissue expander/implant-based breast reconstruction:  evidence-based review.
abstract: BACKGROUND
  The benefits of acellular dermal matrix for breast reconstruction have been well described. However, its clinical impact for breast reconstruction in the setting of radiation therapy has not been well reported.
  
  
  METHODS
  The MEDLINE and EMBASE databases were reviewed for articles published between January of 2005 and February of 2012 on breast reconstruction using acellular dermal matrix in the setting of radiation therapy. The authors also reviewed their institutional experience of consecutive patients who met these criteria between January of 2008 and October of 2011.
  
  
  RESULTS
  Thirteen articles were identified for review: three animal studies on acellular dermal matrix and 10 with level III evidence of its use in humans. The 10 clinical studies included 246 irradiated patients. The M. D. Anderson experience included 30 irradiated acellular dermal matrix patients for a total of 276 irradiated patients evaluated in this review. Use of acellular dermal matrix in implant-based breast reconstruction in the setting of radiation therapy did not predispose to higher infection or overall complication rates or prevent bioprosthetic mesh incorporation. However, the rate of mesh incorporation may be slowed. Its use allowed for increased intraoperative saline fill volumes, which improved aesthetic outcomes and allowed patients to awake from surgery with a formed breast.
  
  
  CONCLUSIONS
  Use of acellular dermal matrix for implant-based breast reconstruction does not appear to increase or decrease the risk of complications, but it might provide psychological and aesthetic benefits. Multicenter or single-center randomized controlled trials that provide high-quality, level I evidence are warranted.
authors.affiliation: Houston, Texas From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Clemens
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Kronowitz
mesh_terms: D062088:Acellular Dermis / Q000528:radiation effects*; D000818:Animals; D001940:Breast / Q000473:pathology / Q000528:radiation effects*; D019928:Breast Implantation / Q000379:methods*; D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D004954:Esthetics; D005069:Evaluation Studies as Topic; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D057910:Implant Capsular Contracture / Q000209:etiology* / Q000517:prevention & control; D020007:Implants, Experimental; D016462:Mammaplasty / Q000379:methods*; D015412:Mastectomy, Segmental; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects*; D012965:Sodium Chloride / Q000008:administration & dosage; D013396:Suction; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control; D015625:Tissue Expansion Devices
chemical_list: D012965:Sodium Chloride