Immediate Breast Cancer Reconstruction with or without Dermal Matrix or Synthetic Mesh Support: A Review and Network Meta-Analysis

Pdf Summary

This systematic review and network meta-analysis evaluated the clinical efficacy and safety of different materials used in immediate implant-based breast reconstruction (IBBR) postmastectomy: human acellular dermal matrix (HADM), xenograft acellular dermal matrix (XADM), synthetic mesh, and traditional submuscular placement without ADM or mesh. The analysis included 31 studies with a total of 12,898 patients covering four surgical strategies.<br /><br />Key findings include:<br /><br />- Implant Loss: No significant difference was found among the four methods regarding implant loss, with traditional submuscular placement (no ADM or mesh) ranked best, though not statistically superior.<br /><br />- Overall Complications: Traditional submuscular coverage without ADM or mesh had significantly fewer overall complications compared with HADM. Both XADM and synthetic mesh showed trends toward fewer complications than HADM but without statistical significance.<br /><br />- Infection: Rates of postoperative infection were significantly lower with XADM and no ADM/mesh compared with HADM, suggesting better integration and less bacterial adhesion with XADM and synthetic materials.<br /><br />- Seroma Formation: HADM was associated with higher seroma rates compared to both no ADM/mesh and XADM, possibly due to its material properties such as reduced pliability and lack of fenestration.<br /><br />- Flap Necrosis and Capsular Contracture: No treatment significantly improved odds of flap necrosis or capsular contracture, though synthetic mesh had the lowest flap necrosis rates. The heterogeneity of data limits definitive conclusions.<br /><br />The study highlights that while mesh-assisted techniques (XADM or synthetic mesh) have complication profiles similar to or better than traditional methods, HADM shows increased risks of infection and seroma. The benefits of mesh use include better lower pole shaping and potential cosmetic advantages, though this was outside the scope of the analysis.<br /><br />Limitations include variability in study designs, surgical techniques, and ADM/mesh types used, potential biases, and limited direct comparisons, especially with synthetic mesh. Patient factors such as BMI, smoking, and radiotherapy status were balanced except for higher radiotherapy rates in the XADM group.<br /><br />The authors recommend careful patient selection and consideration of effectiveness, safety, and cost when choosing IBBR materials. More randomized controlled trials comparing XADM and synthetic mesh are needed due to similar risk profiles but different costs. Overall, ADM or mesh-assisted IBBR presents a viable alternative to traditional submuscular implant placement, with the choice tailored to minimized risk and patient preference.

Keywords

immediate implant-based breast reconstruction

human acellular dermal matrix

xenograft acellular dermal matrix

synthetic mesh

submuscular implant placement

implant loss

postoperative infection

seroma formation

flap necrosis

capsular contracture