Efficacy of Acellular Dermal Matrix Type in Treatment of Capsular Contracture in Breast Augmentation: A Systematic Review and Meta-Analysis.

BACKGROUND

Capsular contracture is a known complication of breast augmentation and is among the top reasons for revision breast augmentation procedures. The use of acellular dermal matrices (ADM) has been shown to reduce the rate of capsular contracture in breast reconstruction and augmentation theorizing that it acts as a protective barrier between the implant capsule and inflammatory process responsible for capsular contracture. The role of ADM in treatment of capsular contracture has been investigated in numerous studies, using a variety of ADM.

OBJECTIVES

The aim of this study was to perform a systematic review of existing literature on the use of ADM for treatment of capsular contracture in aesthetic breast augmentation patients to investigate differences in efficacy between ADM types.

METHODS

PubMed, Embase, and CINAHL databases were systematically reviewed for articles pertaining to capsular contracture, acellular dermal matrices, and breast augmentation. Number of patients, type of ADM, Baker grade, follow-up time, complication rate, and capsular contracture rate were recorded from identified articles. Data was pooled from studies to calculate a capsular contracture rate for each ADM type with Chi-squared test performed for analysis. Identified studies with a comparative group were included in meta-analysis utilizing risk ratio (RR) to assess efficacy of ADM.

RESULTS

Nine articles using ADM for treatment of capsular contracture in breast augmentation met criteria for inclusion with a total of 481 breasts. Strattice (Lifecell Corporation, Branchburg, NJ) was the most commonly used ADM (n=391), followed by AlloDerm (n=57; Lifecell Corporation). There was a statistically significant difference in efficacy of ADM among the studied ADM types (p < 0.001). AlloDerm, FlexHD (MTF Biologics, Edison, NJ), and DermaMatrix have the lowest capsular contracture rates (0%). NeoForm (Mentor Corporation, Irving, TX) and SurgiMend (Integra LifeSciences, Princeton, NJ) have the highest capsular contracture rates (each 25%, but with n=4 and n=8, respectively). Strattice has a capsular contracture rate of 1.53% in the pooled data, and meta-analysis showed that Strattice reduces the risk of capsular contracture (RR 0.14 [95% CI 0.06, 0.31]) compared to conventional treatment.

CONCLUSIONS

Acellular dermal matrices appear to be effective at treating capsular contracture after breast augmentation while maintaining a low complication rate. Overall capsular contracture rates are low with the use of ADM. There is a statistically significant difference in efficacy among ADM type. Meta-analysis shows that Strattice is effective at reducing the risk of capsular contracture in breast augmentation patients compared to conventional treatment. Future research, especially in the form of randomized-controlled trials, is needed to further investigate the efficacy of various ADM in the treatment of capsular contracture.

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