title: Acellular dermal matrices and radiotherapy in breast reconstruction: a systematic review and meta-analysis of the literature.
abstract: The increasing use of commercially available acellular dermis matrices for postmastectomy breast reconstruction seems to have simplified the surgical procedure and enhanced the outcome. These materials, generally considered to be highly safe or with only minor contraindications due to the necessary manipulation in preparatory phases, allow an easier one-phase surgical procedure, in comparison with autologous flaps, offering a high patient satisfaction. Unfortunately, the claim for a higher rate of complications associated with irradiation at the implant site, especially when the radiation therapy was given before the reconstructive surgery, suggested a careful behaviour when this technique is preferred. However, this hypothesis was never submitted to a crucial test, and data supporting it are often discordant or incomplete. To provide a comprehensive analysis of the field, we searched and systematically reviewed papers published after year 2005 and registered clinical trials. On the basis of a meta-analysis of data, we conclude that the negative effect of the radiotherapy on the breast reconstruction seems to be evident even in the case of acellular dermis matrices aided surgery. However, more trials are needed to make solid conclusions and clarify the poor comprehension of all the factors negatively influencing outcome.
authors.affiliation: Department of Biotechnology & Life Science (DBSV), University of Insubria, 21100 Varese, Italy ; Plastic and Reconstructive Surgery Division, Ospedale di Circolo di Varese, Viale Borri 57, 21100 Varese, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Valdatta
authors.affiliation: Department of Biotechnology & Life Science (DBSV), University of Insubria, 21100 Varese, Italy.
authors.forename: Anna Giulia
authors.identifier: 0000-0001-5685-3684
authors.initials: AG
authors.lastname: Cattaneo
authors.affiliation: Plastic and Reconstructive Surgery Division, Ospedale di Circolo di Varese, Viale Borri 57, 21100 Varese, Italy.
authors.forename: Igor
authors.identifier: 0000-0002-7963-4262
authors.initials: I
authors.lastname: Pellegatta
authors.affiliation: Plastic and Reconstructive Surgery Division, Ospedale di Circolo di Varese, Viale Borri 57, 21100 Varese, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Scamoni
authors.affiliation: Department of Biotechnology & Life Science (DBSV), University of Insubria, 21100 Varese, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Minuti
authors.affiliation: Department of Biotechnology & Life Science (DBSV), University of Insubria, 21100 Varese, Italy ; Plastic and Reconstructive Surgery Division, Ospedale di Circolo di Varese, Viale Borri 57, 21100 Varese, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Cherubino