Complications After Prepectoral Versus Subpectoral Breast Reconstruction in Patients Receiving Postmastectomy Radiation Therapy: A Systematic Review and Meta-Analysis

Abstract

Background: Outcomes of immediate breast reconstructions can be influenced by postoperative radiotherapy. However, there is no clarity on the use of prepectoral or subpectoral breast reconstruction in the setting of postmastectomy radiation therapy (PMRT). We reviewed evidence on the complication rates of prepectoral and subpectoral breast reconstruction in women undergoing PMRT.

Methods: PubMed, Web of Science, and Embase databases were scanned for studies comparing complication rates of prepectoral and subpectoral breast reconstruction with PMRT. All complications were pooled in a random-effect meta-analysis to obtain odds ratio (OR).

Results: Eight observational studies were included. Meta-analysis showed no difference in the risk of infections (OR: 1.22 95% CI 0.79, 1.88 I²=0%), implant loss (OR: 0.86 95% CI 0.50, 1.50 I²=14%), seroma (OR: 1.01 95% CI 0.43, 2.34 I²=50%), hematoma (OR: 0.44 95% CI 0.12, 1.71 I²=0%), wound dehiscence (OR: 0.95 95% CI 0.42, 2.17 I²=0%), and skin necrosis (OR: 0.61 95% CI 0.21, 1.75 I²=36%), contracture (OR: 0.46 95% CI 0.15, 1.48 I²=54%) and the need for revision surgeries (OR: 0.85 95% CI 0.45, 1.60 I²=15%) between the prepectoral and subpectoral groups.

Conclusions: Data from observational studies indicates that in appropriately selected patients there may not be any difference in the risk of early complications with prepectoral or subpectoral breast reconstruction with PMRT. Current evidence is limited by the small number of studies, short follow-up and selection bias. There is a need for randomized controlled trials comparing the two approaches to obtain robust evidence on long-term outcomes.

Level of evidence iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Keywords: Breast cancer; Breast implant; Infection; Mastectomy; Radiotherapy; Tissue expander.