The use of porcine acellular dermal matrices in implant-based breast reconstruction: A systematic literature review

Objective: This systematic literature review was conducted to assess outcomes reported with the use of porcine acellular dermal matrices (ADMs), Strattice and Artia, for implant-based breast reconstruction (IBBR). Methods: Articles were identified using multi-string searches of PubMed, Embase, and Medline and targeted searches of recent reviews. Hits were screened against prespecified criteria to identify those reporting adverse events or complications with Strattice or Artia in IBBR. Proportions of breasts affected were determined for implant loss, major and minor complications, and necrosis based on cohorts reporting those outcomes and analyzed descriptively. Results: A total of 14 studies were identified; of those, three studies reported multiple cohorts, for a total of 18 observational cohorts (Strattice only, 13 cohorts; Artia only, two cohorts; both products, three cohorts). Follow-up for all cohorts ranged from 3.0 months to 51.6 months. The overall pooled proportion of breasts with implant loss was 7.6% (range, 0% to 27.5%; n = 1572 breasts, 15 cohorts). Among seven cohorts (n = 704 breasts) reporting major and minor complications, pooled rates were 9.8% (range, 0% to 28.6%) and 10.8% (range, 7.5% to 27.5%) for major and minor complications, respectively. The pooled rate of skin necrosis was 4.0% (range, 0.9% to 20.4%; n = 796 breasts, seven cohorts). Pooled implant loss and necrosis rates for Strattice procedures were lower than the overall pooled rates. Conclusions: In this systematic literature review, pooled rates of implant loss, major complications, minor complications, and skin necrosis for IBBR using the porcine ADMs Strattice and Artia were comparable with previously reported rates for ADM-assisted IBBR. Additional studies are needed to assess outcomes with Artia in IBBR.