Seroma in Prosthetic Breast Reconstruction

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The following comments refer to “Seroma in Prosthetic Breast Reconstruction” (Plast Reconstr Surg. 2016;137:1104–1116), which I read with interest.1 The authors collected and analyzed data according to the Cochrane Handbook for Systematic Reviews of Interventions,2 and a search was performed of the Cochrane Library, Web of Science, Embase, MEDLINE, and Google Scholar databases from 2000 through January of 2015. The authors used the following search terms: “seroma,” “breast,” “tissue expander,” “implant,” and “reconstruction.” They first eliminated studies by titles and abstracts, and then by study methods.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) is an evidence-based minimum set of items for reporting in systematic reviews and meta-analyses.3 Preferred Reporting Items for Systematic Reviews and Meta-Analyses focuses on reviews evaluating randomized trials, but can also be used as a basis for reporting systematic reviews of other types of research, particularly evaluations of interventions.
The authors did not specify the combination of the search terms (AND, OR) or use a flowchart. In a systematic review or meta-analysis, accurate data presentation is essential. A correctly presented literature search and the inclusion of a precise flow sheet using Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards are needed in future systematic reviews.
The authors found the pooled relative risk of seroma associated with the use of acellular dermal matrix to be 1.83 (95 percent CI, 1.28 to 2.62). In our analysis of Table 3, I noticed that the odds ratio for seroma associated with acellular dermal matrix decreased with the year of publication [y = −0.527x + 1062.561; p = 0.014 (linear regression analysis)] (Fig. 1). This indicates that the risk of seroma when acellular dermal matrix was used decreased over time. Although all of the authors (18 of 18) of the analyzed articles used AlloDerm (LifeCell Corp., Branchburg, N.J.), it is thought that both surgical techniques and the quality of acellular dermal matrix materials have improved over time and continue to do so.
The authors reported that the seroma rate when one drain was used (3.4 percent; 95 percent CI, 2.3 to 4.6 percent) was lower than when two drains were used (6.0 percent; 95 percent CI, 3.4 to 8.6 percent), without interpretation. I would like to inquire whether the authors believe that using only one drain is better than using two drains for preventing seroma.

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