title: A Meta-analysis of Postoperative Complications of Tissue Expander/Implant Breast Reconstruction Using Acellular Dermal Matrix.
abstract: BACKGROUND
  Acellular dermal matrix (ADM) is commonly used for tissue expander/implant breast (TE/I-based) reconstruction. But the relation between ADM and postoperative complications remains controversial. A few meta-analyses were conducted in 2011-2012 and the result revealed that ADM can increase the risk of complications. The purpose of our study is to offer updated evidence for ADM clinical application by analyzing the effect of ADM on complications of TE/I-based breast reconstruction.
  
  
  METHODS
  The literature published from January 2010 to February 2015 was searched in EMbase, Medline, Science Direct, the Cochrane Central Register of Controlled Trials (CENTRAL), CBMdisc, CNKI, VIP, and the references of those included studies were also searched by hand. According to inclusive criteria, 11 studies were selected and the values were extracted from the included literature. Complications with four different categories assigned for overall complications, infection, hematoma/seroma, and explantation were collected. RevMan 5.1 was used for meta-analysis. The evidence level was assessed by using the GRADE system.
  
  
  RESULTS
  Eleven published studies were included. The results showed that compared to the control group, the ADM group increased the rate of overall complications (OR = 1.33, 95% CI 1.03-1.70, p = 0.03), infection (OR = 1.47, 95% CI 1.04-2.06, p = 0.03), hematoma/seroma (OR = 1.66, 95% CI 1.13-2.44, p = 0.01), but there was no significant difference in explantation (OR = 1.37, 95% CI 0.89-2.11, p = 0.15). Based on the GRADE system, all the evidence was at level C and weak recommendation.
  
  
  CONCLUSIONS
  In TE/I-based breast reconstruction, ADM increased the incidence of overall complications, infection, and hematoma/seroma; the incidence of explantation remains unknown. For the poor quality of the original studies, a prudent choice is suggested; and more high-quality, large-sample studies are needed.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266.
authors.affiliation: Department of Plastic Surgery, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuhan, 430060, Hubei, People's Republic of China.
authors.forename: Xiangyi
authors.initials: X
authors.lastname: Zhao
authors.affiliation: Department of Plastic Surgery, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuhan, 430060, Hubei, People's Republic of China. 904949860@qq.com.
authors.forename: Xiaowei
authors.initials: X
authors.lastname: Wu
authors.affiliation: Department of Plastic Surgery, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuhan, 430060, Hubei, People's Republic of China.
authors.forename: Jie
authors.initials: J
authors.lastname: Dong
authors.affiliation: Department of Plastic Surgery, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuhan, 430060, Hubei, People's Republic of China.
authors.forename: Yingying
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Plastic Surgery, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuhan, 430060, Hubei, People's Republic of China.
authors.forename: Liang
authors.initials: L
authors.lastname: Zheng
authors.affiliation: Department of Plastic Surgery, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuhan, 430060, Hubei, People's Republic of China.
authors.forename: Liming
authors.initials: L
authors.lastname: Zhang
mesh_terms: D062088:Acellular Dermis; D018427:Breast Implants / Q000009:adverse effects*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D015625:Tissue Expansion Devices / Q000009:adverse effects*
keywords: Acellular dermal matrix; Breast reconstruction; Meta-analysis