The Evolving Role and Outcomes of Acellular Dermal Matrix (ADM) in Post-Mastectomy Breast Reconstruction: A Systematic Literature Review

Introduction: Acellular dermal matrix (ADM) is commonly used as an adjunct in implant-based breast reconstruction following mastectomy. However, its routine application remains controversial, with conflicting evidence regarding clinical benefit, safety, and cost-effectiveness. Methods: A systematic literature review was conducted of clinical studies published between January 2010 and November 2025 evaluating ADM-assisted implant-based breast reconstruction. Eligible studies included randomised controlled trials, prospective and retrospective cohort studies, non-randomised comparative studies, and case series involving ≥10 patients. Outcomes of interest were postoperative complications, aesthetic outcomes, patient-reported satisfaction, and economic considerations. Searches were performed using PubMed, Scopus/Elsevier, and Google Scholar, with study selection conducted in accordance with PRISMA guidelines. Results: Across included studies, ADM use did not consistently demonstrate improvements in short-term aesthetic outcomes, patient-reported quality of life, or early postoperative complication rates compared with conventional techniques. In contrast, long-term data from large prospective cohorts suggested a lower incidence of capsular contracture associated with ADM use. In contemporary reconstructive practice, particularly prepectoral implant placement, ADM was associated with acceptable short-term safety in appropriately selected patients. Patient-related factors, including obesity, smoking, and diabetes, were consistently associated with increased complication risk. Although ADM is associated with higher upfront costs, evidence regarding long-term cost-effectiveness remains limited. Conclusions: ADM should be considered a selective adjunct rather than a routine component of implant-based breast reconstruction. Its primary clinical value appears to relate to long-term modulation of fibrosis rather than short-term outcomes. Individualised patient selection and surgical strategy are essential, and further high-quality prospective and economic studies are needed to better define their role.