Complications of Prosthetic Breast Reconstruction in Prophylactic Versus Therapeutic Mastectomy: A Systematic Review and Meta-analysis

Abstract

Background: Although not routinely advocated for average-risk patients, contralateral prophylactic mastectomy (CPM) is recommended by current guidelines to reduce mortality in high-risk patients with unilateral breast cancer. This systematic review and meta-analysis aimed to provide a comprehensive quantitative assessment on the risk associated with implant-based reconstruction in CPM versus therapeutic mastectomy (TM).

Methods: A priori criteria were applied to perform a systematic review and meta-analysis of all existing comparative studies on postoperative complications associated with implant-based breast reconstruction after CPM or TM. The fixed-effects model was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs).

Results: Five studies were included in the final analysis, representing 3543 patients who underwent 6401 mastectomies (3260 TM and 3141 CPM), followed by prosthetic breast reconstruction including tissue expanders and direct-to-implant procedures. Reconstructions after TM were associated with a statistically significantly higher risk of postoperative infections (OR = 2.03 [95% CI: 1.50-2.73]) and explantation rates (OR = 2.41 [95% CI: 1.77-3.28]). No significant differences were observed between the 2 groups in the occurrence of hematoma, seroma, necrosis, and capsular contracture.

Conclusions: Implant-based breast reconstruction after CPM demonstrates a lower risk of postoperative complications compared with TM. This knowledge and the quantification of risk summarized in this article should be integrated in the shared decision-making with patients and in preoperative information.

Fig. 1.

Flowchart detailing the study selection process in adherence to PRISMA guidelines. It outlines the number of records identified, screened, excluded, and included in the final analysis. **We excluded any study that did not directly compare IBBR after therapeutic vs prophylactic mastectomy, as well as those that, despite comparing IBBR in either setting, failed to report postoperative outcomes.

Fig. 2.

Forest plot comparing postoperative infection rates between TM and CPM. The “favors prophylactic” region indicates fewer complications observed in the CPM group.

Fig. 3.

Forest plot comparing postoperative explantation rates between TM and CPM. The “favors prophylactic” region indicates fewer cases of explantation in the CPM group.

Fig. 4.

Forest plot comparing postoperative mastectomy flap necrosis rates between TM and CPM. The “favors prophylactic” region suggests reduced necrosis in the CPM group.

Fig. 5.

Forest plot comparing postoperative capsular contracture rates between TM and CPM. The “favors prophylactic” region highlights a reduction in capsular contracture in the CPM group.

Fig. 6.

Forest plot comparing postoperative hematoma formation rates between TM and CPM. The “favors prophylactic” region indicates fewer occurrences of hematoma in the CPM group.

Fig. 7.

Forest plot comparing postoperative seroma formation rates between TM and CPM. The “favors prophylactic” region indicates fewer occurrences of seroma in the CPM group.