Cinquini Michela, Rocco Nicola, Catanuto Giuseppe, Garreffa Emanuele, Ferrando Pietro Maria, Gonzalez-Lorenzo Marien, Maglia Anna, Montagna Giacomo, Villanucci Amedeo, Visintini Cividin Valentina, Nava Maurizio Bruno
Unit of Systematic Reviews Methodology and Guidelines Production, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
G.RE.T.A. Group for Reconstructive and Therapeutic Advancements, Naples, Catania, Italy.
Plast Reconstr Surg Glob Open. 2023 Feb 22;11(2):e4821. doi: 10.1097/GOX.0000000000004821. eCollection 2023 Feb.
Acellular dermal matrices (ADMs) entered the market in the early 2000s and their use has increased thereafter. Several retrospective cohort studies and single surgeon series reported benefits with the use of ADMs. However, robust evidence supporting these advantages is lacking. There is the need to define the role for ADMs in implant-based breast reconstruction (IBBR) after mastectomy.
A panel of world-renowned breast specialists was convened to evaluate evidence, express personal viewpoints, and establish recommendation for the use of ADMs for subpectoral one-/two-stage IBBR (compared with no ADM use) for adult women undergoing mastectomy for breast cancer treatment or risk reduction using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.
Based on the voting outcome, the following recommendation emerged as a consensus statement: the panel members suggest subpectoral one- or two-stage IBBR either with ADMs or without ADMs for adult women undergoing mastectomy for breast cancer treatment or risk reduction (with very low certainty of evidence).
The systematic review has revealed a very low certainty of evidence for most of the important outcomes in ADM-assisted IBBR and the absence of standard tools for evaluating clinical outcomes. Forty-five percent of panel members expressed a conditional recommendation either in favor of or against the use of ADMs in subpectoral one- or two-stages IBBR for adult women undergoing mastectomy for breast cancer treatment or risk reduction. Future subgroup analyses could help identify relevant clinical and pathological factors to select patients for whom one technique could be preferable to another.
脱细胞真皮基质（ADM）于21世纪初进入市场，此后其使用量不断增加。多项回顾性队列研究和单外科医生系列报道了使用ADM的益处。然而，缺乏支持这些优势的有力证据。有必要明确ADM在乳房切除术后基于植入物的乳房重建（IBBR）中的作用。
召集了一组世界知名的乳腺专家，以评估证据、表达个人观点，并就使用ADM进行胸肌下一期/二期IBBR（与不使用ADM相比）为因乳腺癌治疗或降低风险而接受乳房切除术的成年女性制定建议，采用推荐分级、评估、制定与评价（GRADE）方法。
根据投票结果，以下建议作为共识声明出现：小组成员建议，对于因乳腺癌治疗或降低风险而接受乳房切除术的成年女性，胸肌下一期或二期IBBR可使用ADM，也可不使用ADM（证据确定性非常低）。
系统评价显示，ADM辅助的IBBR中大多数重要结局的证据确定性非常低，且缺乏评估临床结局的标准工具。45%的小组成员对因乳腺癌治疗或降低风险而接受乳房切除术的成年女性在胸肌下一期或二期IBBR中使用ADM表示有条件的支持或反对。未来的亚组分析可能有助于确定相关的临床和病理因素，以选择对一种技术比另一种技术更合适的患者。
