3 years ago

Complications, patient-reported outcomes, and aesthetic results in immediate breast reconstruction with a dermal sling: a systematic review and meta-analysis

Christian Jepsen, Håkan Hallberg, Aldina Pivodic, Anna Elander, Emma Hansson

Publication date: Available online 8 January 2019

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): Christian Jepsen, Håkan Hallberg, Aldina Pivodic, Anna Elander, Emma Hansson


An inferior dermal flap (“sling”) can be used to cover an implant with two layers of tissue following Wise pattern skin-reducing mastectomies. Here, we performed a systematic review of the risks and benefits of this technique, specifically regarding complications, patient-reported outcomes, and aesthetic outcomes. PubMed and other relevant databases were searched using specific key words, with inclusion criteria comprising studies of dermal sling use involving ≥5 patients and performance according to the PICO framework. A meta-analysis was performed using a random-effects model involving a binomial distribution with logit-link function. For each study, the 95% confidence interval (CI) was obtained based on exact limits from a binomial distribution, and heterogeneity testing was performed using a chi-squared test. A total of 428 abstracts were retrieved, with 24 studies meeting the inclusion criteria and including a total of 879 patients and 1184 reconstructed breasts. The mean complication rate was 21.6% (95% CI: 16.9–27.2%), with the most common complication involving wound-healing problems (mean, 11.4%; 95% CI: 8.5–15.2%), and the frequency of implant loss (<3 months) varied from 0% to 14% (mean, 2.2%; 95% CI: 1.1–4.4%). Seven articles reported patient-reported outcomes, and four reported aesthetic outcomes, with the quality of evidence classified as low for complications and very low for patient-reported outcomes and aesthetic outcomes. Our findings showed that although implant-based reconstruction with a dermal sling is widely used, there is little scientific evidence supporting the method.

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