Does the use of Acellular Dermal Matrices (ADM) in women undergoing pre-pectoral implant-based breast reconstruction increase operative success versus non-use of ADM in the same setting? A systematic review protocol

Abstract Background Breast cancer is the most common malignancy among women in the UK. Following mastectomy, reconstruction is now integral to the surgical management of breast cancer, of which implant-based reconstruction (IBBR) is the most common type. IBBR initially evolved from pre-pectoral to post-pectoral due to complications but with developments in oncoplastic techniques and new implant technology, interest in pre-pectoral IBBR has increased. Many surgeons use Acellular Dermal Matrices (ADM) however there is little evidence in literature as to whether this improves surgical outcomes in terms of complications, failure and patient satisfaction. This review aims to assess the available evidence as to whether there is a difference in surgical outcomes for breast reconstructions using ADM versus non-use of ADM. Methods A database search will be performed using Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews. The search timeframe will be 10 years. Studies will be screened using inclusion and exclusion criteria and data extracted into a standardised spreadsheet. Risk of Bias will be assessed using the Newcastle Ottawa scale and ROBIS tools. Screening, extraction and risk of bias assessments will be performed independently by two reviewers and discrepancies discussed and rectified. Data analysis and meta-analysis (if appropriate) will be performed, and heterogeneity assessed. Discussion With the renaissance of pre-pectoral IBBR, it is important that surgeons have adequate evidence available to assist operative decision making. Assessing evidence in literature is important to help surgeons determine whether using ADM for IBBR is beneficial compared to non-use of ADM. This has potential impacts for patient complications, satisfaction and cost to healthcare trusts. Systematic Review Registration This review was registered with the International prospective register of systematic reviews (PROSPERO), part of the National Institute for Health Research (NIHR). Registration is as follows: PROSPERO 2023 CRD42023389072. The review registration is available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023389072