Breast reconstruction and adjuvant therapy: A systematic review of surgical outcomes

El‐Sabawi, Bassim; Sosin, Michael; Carey, Joseph N.; Nahabedian, Maurice Y.; Patel, Ketan M.

doi:10.1002/jso.24028

Cited by 107 publications

(87 citation statements)

References 84 publications

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“…However, the group with the irradiated permanent implants had significantly increased grade IV capsular contracture rates (6.3% vs. 1.2%; P < 0.01). These results, are consistent with a recent systematic review and pooled analysis that demonstrated that PMRT to permanent implants reduces the rate of reconstructive failure (18.8% vs. 14.7%; P < 0.01) [39]. Despite this, irradiating the tissue expander remains common as many patients that receive neoadjuvant chemotherapy are not candidates for delaying PMRT until after the exchange procedure.…”

Section: Surgical Outcomessupporting

confidence: 90%

Radiation and breast reconstruction: Algorithmic approach and evidence-based outcomes

et al. 2016

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Postmastectomy radiation (PMRT) in the setting of immediate breast reconstruction has been associated with increased complications and poorer aesthetic outcomes for both autologous and implant reconstructions. Many centers have attempted to mitigate the deleterious effects associated with radiation by implementing an algorithmic approach to breast reconstruction. Although the literature regarding the optimal timing of radiotherapy and breast reconstruction remains controversial, reported outcomes following various algorithms have been encouraging and warrant further consideration. J. Surg. Oncol. 2016;113:906-912. © 2016 Wiley Periodicals, Inc.

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Section: Surgical Outcomessupporting

confidence: 90%

Radiation and breast reconstruction: Algorithmic approach and evidence-based outcomes

et al. 2016

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“…Multiple studies have reported on the increased morbidity associated with all forms of immediate breast reconstruction in the setting of PMRT 5–7 . Early studies on flap exposure to radiation found significant rates of flap fibrosis, fat necrosis, and shrinkage which in severe cases could necessitate flap replacement 8,9 .…”

Section: Introductionmentioning

confidence: 99%

Should Immediate Autologous Breast Reconstruction Be Considered in Women Who Require Postmastectomy Radiation Therapy? A Prospective Analysis of Outcomes

Billig

Jagsi

et al. 2017

Plastic &Amp; Reconstructive Surgery

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Background In women who require post-mastectomy radiation therapy, immediate autologous breast reconstruction is often discouraged. We aim to prospectively evaluate postoperative morbidity and satisfaction reported by women undergoing delayed or immediate autologous breast reconstruction in the setting of post-mastectomy radiation therapy. Methods Patients enrolled in the Mastectomy Reconstruction Outcomes Consortium Study, who received post-mastectomy radiotherapy and had immediate or delayed free abdominal-based autologous breast reconstruction were identified. Postoperative complications at one and two years after reconstruction were assessed. Patient reported outcomes were evaluated using the BREAST-Q questionnaire preoperatively, at one and two-years postoperatively. Bivariate analyses and mixed-effects regression models were used to compare outcomes. Results A total of 175 patients met our inclusion criteria. Immediate reconstructions were performed in 108 patients and delayed reconstructions in 67 patients. 93.5% of the immediate reconstructions were performed at a single center. Overall complication rates were similar based on reconstructive timing (25.9% immediate and 26.9% delayed at one year; p=0.54). Patients with delayed reconstruction reported significantly lower pre-reconstruction scores (p<0.0001) for satisfaction with breast, psychosocial and sexual well-being than did patients with immediate reconstruction. At one and two years postoperatively, both groups of patients reported comparable levels of satisfaction in assessed BREAST-Q domains. Conclusions From this prospective cohort, immediate autologous breast reconstruction in the setting of post-mastectomy radiation therapy appears to be a safe option that may be considered in select patients and centers. Breast aesthetics and quality of life, evaluated from the patient’s perspective, were not compromised by flap exposure to radiation therapy.

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“…The reason for this is multifactorial but likely related to its technical feasibility, lack of donor site morbidity, and changes in mastectomy patterns, such as increased bilateral mastectomies. Despite these advantages, risk of potential complications and unsatisfactory long term aesthetic outcomes are significantly increased as compared to autologous reconstruction [13,30] . In this review, capsular contracture, poor cosmesis, persistent pain, and infection were the most commonly cited reasons for patients choosing to undergo tertiary reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…Prosthetic reconstruction is the most common method of breast reconstruction and has increased at a rate of 5% a year [12] . Despite its increasing popularity, complications leading to poor aesthetics, persistent pain, and implant loss are not uncommon, particularly in the setting of adjuvant radiotherapy [13,14] . In addition to alleviating implant-related complications, autologous conversion may provide a more natural appearance and improve longevity of the reconstructed breast.…”

Section: Introductionmentioning

confidence: 99%

Microsurgical restoration of failed or unsatisfactory breast reconstruction: a systematic review and pooled-analysis of outcomes

El‐Sabawi¹,

Howell²,

Patel³

2017

PAR

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Aim: Autologous tissue transfer to salvage breast reconstruction following a previously failed or unsatisfactory reconstruction has been described by previous studies to be an effective strategy to optimize outcomes. The purpose of this systematic review is to assimilate the relevant literature to evaluate surgical and aesthetic outcomes following autologous breast reconstruction in the setting of a prior unsuccessful reconstruction. Methods: A systematic review of the English literature was performed on Pubmed/MEDLINE to identify all manuscripts reporting surgical outcomes, aesthetic outcomes, or patient satisfaction of autologous breast reconstruction in the setting of a previously failed or unsatisfactory breast reconstruction. Results: Nineteen studies met the criteria for inclusion. Of these, 15 studies reported outcomes following autologous conversion of unsuccessful prosthetic reconstruction (778 breasts). Pooled-analysis of these studies demonstrated total flap loss in 1.6%, microsurgical revision in 3.2%, total complications in 21.7%, and revision surgery in 26.5%. Review of these studies demonstrated high rates of positive aesthetic outcomes and patient satisfaction. Five studies (54 patients) evaluated outcomes following autologous salvage of prior unsuccessful autologous breast reconstruction. Pooled-analysis of these studies demonstrated no instances of microsurgical revision, total complications in 42.2%, and revision surgery in 70.0%. Total flap failure following tertiary reconstruction utilizing microsurgical free flaps occurred in 9.5%. Data describing aesthetic outcomes or patient satisfaction was lacking in these studies. Conclusion: Autologous conversion in the setting of unsuccessful prosthetic breast reconstruction appears to be valuable option to improve outcomes. There is little evidence to suggest that prior prosthetic reconstruction negatively impacts outcomes of autologous breast reconstruction. Data describing autologous breast reconstruction following prior flap loss is limited but suggests it is viable method to salvage breast reconstruction in appropriate patients. ABSTRACT

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Breast reconstruction and adjuvant therapy: A systematic review of surgical outcomes

Cited by 107 publications

References 84 publications

Radiation and breast reconstruction: Algorithmic approach and evidence-based outcomes

Radiation and breast reconstruction: Algorithmic approach and evidence-based outcomes

Should Immediate Autologous Breast Reconstruction Be Considered in Women Who Require Postmastectomy Radiation Therapy? A Prospective Analysis of Outcomes

Microsurgical restoration of failed or unsatisfactory breast reconstruction: a systematic review and pooled-analysis of outcomes

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