Oncoplastic Breast Reduction: A Systematic Review of Postoperative Complications

Abstract

Background: Breast-conserving therapy with oncoplastic reduction is a useful strategy for partial mastectomy defect reconstruction. The most recently published systematic review of oncoplastic breast reduction outcomes from 2015 showed wound dehiscence in 4.3%, hematoma in 0.9%, infection in 2.8%, and nipple necrosis in 0.9% of patients. We performed a systematic review of oncoplastic breast reduction literature, comparing outcomes and complication rates reported over the past 8 years.

Methods: Studies describing the use of oncoplastic breast reduction and discussion of postoperative complications were included. The primary outcome assessed was the postoperative complication rate; secondary outcomes analyzed were rates of margin expansion, completion mastectomy, and delays in adjuvant therapy due to complications.

Results: Nine articles met inclusion criteria, resulting in 1715 oncoplastic breast reduction patients. The mean rate of hematoma was 3%, nipple necrosis was 2%, dehiscence was 4%, infection was 3%, and seroma was 2%. The need for re-excision of margins occurred in 8% of patients, and completion mastectomy in 2%. Finally, delay in adjuvant treatment due to a postoperative complication occurred in 4% of patients.

Conclusions: Oncoplastic breast reduction is an excellent option for many patients undergoing breast-conserving therapy; however, postoperative complications can delay adjuvant radiation therapy. Results of this systematic literature review over the past 8 years showed a slight increase in complication rate compared to the most recent systematic review from 2015. With increased popularity and surgeon familiarity, oncoplastic breast reduction remains a viable option for reconstruction of partial mastectomy defects despite a slight increase in complication rate.

Fig. 1.

Proportions for hematoma. We performed a random-effects meta-analysis on summary data from the eight studies that reported hematoma postoperative complications. The boxes represent estimated proportions, with the sizes of the boxes indicating the inverse variance of the eight studies, and the horizontal lines represent their 99% CIs. The diamond represents the pooled proportion. The width of the diamond represents the width of the 99% CI of the pooled proportion.

Fig. 2.

Proportions for nipple or nipple-areolar complex necrosis. We performed a random-effects meta-analysis on summary data from the six studies that reported nipple or nipple-areolar complex necrosis postoperative complications. The boxes represent estimated proportions, with the sizes of the boxes indicating the inverse variance of the six studies, and the horizontal lines represent their 99% CIs. The diamond represents the pooled proportion. The width of the diamond represents the width of the 99% CI of the pooled proportion.

Fig. 3.

Proportions for wound dehiscence. We performed a random-effects meta-analysis on summary data from the six studies that reported wound dehiscence postoperative complications. The boxes represent estimated proportions, with the sizes of the boxes indicating the inverse variance of the six studies, and the horizontal lines represent their 99% CIs. The diamond represents the pooled proportion. The width of the diamond represents the width of the 99% CI of the pooled proportion.

Fig. 4.

Proportions for infection. We performed a random-effects meta-analysis on summary data from the eight studies that reported infection postoperative complications. The boxes represent estimated proportions, with the sizes of the boxes indicating the inverse variance of the eight studies, and the horizontal lines represent their 99% CIs. The diamond represents the pooled proportion. The width of the diamond represents the width of the 99% CI of the pooled proportion.

Fig. 5.

Proportions for seroma. We performed a random-effects meta-analysis on summary data from the eight studies that reported seroma postoperative complications. The boxes represent estimated proportions, with the sizes of the boxes indicating the inverse variance of the eight studies, and the horizontal lines represent their 99% CIs. The diamond represents the pooled proportion. The width of the diamond represents the width of the 99% CI of the pooled proportion.

Fig. 6.

Proportions for re-excision for positive margins on pathologic analysis. We performed a random-effects meta-analysis on summary data from the eight studies that reported re-excision for positive margins on pathologic analysis. The boxes represent estimated proportions, with the sizes of the boxes indicating the inverse variance of the eight studies, and the horizontal lines represent their 99% CIs. The diamond represents the pooled proportion. The width of the diamond represents the width of the 99% CI of the pooled proportion.

Fig. 7.

Proportions for completion mastectomy. We performed a random-effects meta-analysis on summary data from the eight studies that reported completion mastectomy. The boxes represent estimated proportions, with the sizes of the boxes indicating the inverse variance of the eight studies, and the horizontal lines represent their 99% CIs. The diamond represents the pooled proportion. The width of the diamond represents the width of the 99% CI of the pooled proportion.

Fig. 8.

Proportions for delay in adjuvant treatment due to a postoperative complication. We performed a random-effects meta-analysis on summary data from the four studies that reported a delay in adjuvant treatment due to a postoperative complication. The boxes represent estimated proportions, with the sizes of the boxes indicating the inverse variance of the four studies, and the horizontal lines represent their 99% CIs. The diamond represents the pooled proportion. The width of the diamond represents the width of the 99% CI of the pooled proportion.