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Nipple Reconstruction Using Acellular Dermal Matrix: A Systematic Review and Meta-Analysis of Long-Term Outcomes
Shirley Shue BS, Katherine Grunzweig MD, Anand Kumar MD
Case Western Reserve University School of Medicine
2018-02-15
Presenter: Shirley Shue
Affidavit:
I certify Shirley Shue did the majority of the original work of this project, including conception, literature search, data collection, writing, analysis and revision.
Director Name: Anand Kumar
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
BACKGROUND: Multiple techniques have been described for nipple-areola reconstruction, but maintaining nipple projection remains an ongoing challenge. The purpose of this study was to determine long-term outcomes using acellular dermal matrix (ADM) to reconstruct the nipple.
METHODS: A systematic review and meta-analysis were performed following preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. Relevant articles were divided into those that used local flap reconstruction with ADM and those that used local flap reconstruction without autologous, allogeneic, or synthetic materials. Variables assessed included breast reconstruction technique, local flap type, percent of nipple projection preserved, complications, and follow-up time. Meta-analysis was performed to obtain pooled odds-ratio and an unpaired t-test was performed to compare the percent nipple projection preserved between the two groups.
RESULTS: 26 studies with 1,021 nipples (8 studies with 189 nipples using ADM, 18 studies with 832 nipples without ADM) met inclusion criteria for our systematic review. Long-term nipple projection was significantly greater in patients who received ADM with their local flap reconstruction than those who did not receive ADM (p<0.0001). The complication rate between both groups was not significantly different (OR 0.6016, p=0.2518). Average follow-up was 18.6 months in the patients receiving ADM and 31.3 months in patients not receiving ADM.
CONCLUSION: Use of ADM with local flap nipple reconstruction after implant-based or autologous breast reconstruction can significantly improve long-term nipple reconstruction without increasing risk of complications. The financial burden of ADM can be addressed by banking ADM at time of breast reconstruction.
