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. 2025 Apr 16;32(4):231.
doi: 10.3390/curroncol32040231.

Postmastectomy Breast Reconstruction in Patients with Non-Metastatic Breast Cancer: A Systematic Review

Toni Zhong  1   2 , Glenn G Fletcher  3 , Muriel Brackstone  4   5 , Simon G Frank  6   7 , Renee Hanrahan  2   8   9 , Vivian Miragias  10 , Christiaan Stevens  11   12 , Danny Vesprini  13   14 , Alyssa Vito  15 , Frances C Wright  16   17   18
Affiliations

Postmastectomy Breast Reconstruction in Patients with Non-Metastatic Breast Cancer: A Systematic Review

Toni Zhong et al. Curr Oncol. .

Abstract

Breast reconstruction after mastectomy improves the quality of life for many patients with breast cancer. There is uncertainty regarding eligibility criteria for reconstruction, timing (immediate or delayed-with or without radiotherapy), outcomes of nipple-sparing compared to skin-sparing mastectomy, selection criteria and surgical factors influencing outcomes of nipple-sparing mastectomy, prepectoral versus subpectoral implants, use of acellular dermal matrix, and use of autologous fat grafting. We conducted a systematic review of these topics to be used as the evidence base for an updated clinical practice guideline on breast reconstruction for Ontario Health (Cancer Care Ontario). The protocol was registered on PROSPERO, CRD42023409083. Medline, Embase, and Cochrane databases were searched until August 2024, and 229 primary studies met the inclusion criteria. Most studies were retrospective non-randomized comparative studies; 5 randomized controlled trials were included. Results suggest nipple-sparing mastectomy is oncologically safe, provided there is no clinical, radiological, or pathological indication of nipple-areolar complex involvement. Surgical factors, including incision location, may affect rates of complications such as necrosis. Both immediate and delayed reconstruction have similar long-term outcomes; however, immediate reconstruction may result in better short to medium-term quality of life. Evidence on whether radiotherapy should modify the timing of initial reconstruction or expander-implant exchange was very limited; studies delayed reconstruction after radiotherapy by at least 3 months and, more commonly, at least 6 months to avoid the period of acute radiation injury. Radiation after immediate reconstruction is a reasonable option. Surgical complications are similar between prepectoral and dual-plane or subpectoral reconstruction; prepectoral placement may give a better quality of life due to lower rates of long-term complications such as pain and animation deformity. Autologous fat grafting was found to be oncologically safe; its use may improve quality of life and aesthetic results.

Keywords: acellular dermal matrix; autologous fat grafting; autologous reconstruction; breast implants; breast reconstruction; delayed reconstruction; immediate reconstruction; nipple-sparing mastectomy; prepectoral; subpectoral.

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Conflict of interest statement

C.S. reported receiving honoraria for chairing or moderating two speaker series on updates in oncological advancements to regional surgical, medical, and radiation oncologists. F.C.W. was the surgical oncology provincial lead, a program of Ontario Health (Cancer Care Ontario). The other authors declare no conflicts of interest. The funder approved the research questions and project plan prior to the commencement of the systematic review. The sponsor had no role in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
PRISMA Flow Diagram. Format adapted from Page et al. [23].
Figure 2
Figure 2
Effect of Fat Grafting on Cancer Recurrence.
Figure 3
Figure 3
Effect of Fat Grafting on Survival Outcomes.
See this image and copyright information in PMC

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