Implant-based Breast Reconstruction after Mastectomy for Breast Cancer: A Systematic Review and Meta-analysis

Saldanha, Ian J.; Broyles, Justin M.; Adam, Gaelen P; Cao, Wangnan; Bhuma, Monika Reddy; Mehta, Shivani; Pusic, Andrea L.; Dominici, Laura; Balk, Ethan M

doi:10.1097/gox.0000000000004179

Cited by 18 publications

(19 citation statements)

References 70 publications

(217 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The full details of the SR methodology are provided in a companion article 10 and in the full AHRQ report for the project. 11 Briefly, based on discussions with panels of stakeholders and experts in the field, we prioritized specific benefits and surgical complications for the comparison between IBR and AR in women after mastectomy for treatment or prophylaxis against breast cancer.…”

Section: Methodsmentioning

confidence: 99%

Implant-based versus Autologous Reconstruction after Mastectomy for Breast Cancer: A Systematic Review and Meta-analysis

Broyles

Balk

Adam

et al. 2022

Plastic and Reconstructive Surgery - Global Open

Self Cite

View full text Add to dashboard Cite

Background: For women undergoing breast reconstruction after mastectomy, the comparative benefits and harms of implant-based reconstruction (IBR) and autologous reconstruction (AR) are not well known. We performed a systematic review with meta-analysis of IBR versus AR after mastectomy for breast cancer. Methods: We searched Medline, Embase, Cochrane CENTRAL, CINAHL, and ClinicalTrials.gov for studies from inception to March 23, 2021. We assessed the risk of bias of individual studies and strength of evidence (SoE) of our findings using standard methods. Results: We screened 15,936 citations and included 40 studies (two randomized controlled trials and 38 adjusted nonrandomized comparative studies). Compared with patients who undergo IBR, those who undergo AR experience clinically significant better sexual well-being [summary adjusted mean difference (adjMD) 5.8, 95% CI 3.4–8.2; three studies] and satisfaction with breasts (summary adjMD 8.1, 95% CI 6.1–10.1; three studies) (moderate SoE for both outcomes). AR was associated with a greater risk of venous thromboembolism (moderate SoE), but IBR was associated with a greater risk of reconstructive failure (moderate SoE) and seroma (low SoE) in long-term follow-up (1.5–4 years). Other outcomes were comparable between groups, or the evidence was insufficient to merit conclusions. Conclusions: Most evidence regarding IBR versus AR is of low or moderate SoE. AR is probably associated with better sexual well-being and satisfaction with breasts and lower risks of seroma and long-term reconstructive failure but a higher risk of thromboembolic events. New high-quality research is needed to address the important research gaps.

show abstract

Section: Methodsmentioning

confidence: 99%

Implant-based versus Autologous Reconstruction after Mastectomy for Breast Cancer: A Systematic Review and Meta-analysis

Broyles

Balk

Adam

et al. 2022

Plastic and Reconstructive Surgery - Global Open

Self Cite

View full text Add to dashboard Cite

show abstract

“…The full details of the SR methodology are provided in a companion article 4 and in the full AHRQ report for the project. 6 Briefly, based on discussions with panels of stakeholders and experts, we developed eligibility criteria for the SR. We considered any comparative study [randomized controlled trials (RCTs), or nonrandomized comparative studies (NRCSs) with adequate statistical adjustment analyses) that evaluated timing of AR relative to chemotherapy and radiation therapy or compared any flap types [eg, DIEP, LD, TRAM, superficial inferior epigastric artery perforator (SIEA), lateral thoracodorsal (LTD), thoracodorsal artery perforator (TAP)].…”

Section: Methodsmentioning

confidence: 99%

“…Here, we focus on the SR's research questions concerning AR. Companion articles focus on implant-based reconstruction 4 and the comparison between implant-based reconstruction and AR. 5 All reports focus on women undergoing (or who have undergone) mastectomy for breast cancer treatment or prophylaxis.…”

mentioning

confidence: 99%

Autologous Breast Reconstruction after Mastectomy for Breast Cancer: A Systematic Review

Saldanha

Broyles

Adam

et al. 2022

Plastic and Reconstructive Surgery - Global Open

Self Cite

View full text Add to dashboard Cite

More than 40% of women in the United States who undergo mastectomy for breast cancer have breast reconstruction, 1 amounting to about 107,000 women in 2019. 2 Approximately one in five (19%) reconstruction procedures in the United States involve autologous reconstruction (AR). 2 Once the decision to undergo AR is made, two main considerations are involved: the timing of the procedure relative to chemotherapy and radiation therapy, and the choice of flap. Flap types are generally described by the anatomic region from which the flap tissue is sourced, including the deep inferior epigastric perforator (DIEP; 52% of ARs), latissimus dorsi (LD; 22%), transverse rectus abdominis myocutaneous (TRAM; 21%), and other flaps (5%). 2 The options regarding source of the AR flap may be limited by the patient's body habitus, prior surgery, medical comorbidities, and preference. Each consideration regarding AR (timing and flap type) can have implications on aesthetics, complications, and cost. ObjectivesWe conducted a systematic review (SR) 3 for the Agency for Healthcare Research and Quality (AHRQ) Evidencebased Practice Center Program to support the American Society of Plastic Surgeons in its effort to develop a new

show abstract

“…In total, 20.9% of IBR patients had a history of PMRT, 15.5% of them after reconstruction. Both PMRT before (with/without immediate tissue expander reconstruction) and after IBR-reconstruction have been associated with major CC and implant removal ( 25 , 31 ). This finding can further explain counts of major complications in our IBR patient cohort and underlines the necessity of a detailed informed consent including the risks of IBR after PMRT.…”

Section: Discussionmentioning

confidence: 99%

Autologous vs. implant-based breast reconstruction after skin- and nipple-sparing mastectomy—A deeper insight considering surgical and patient-reported outcomes

et al. 2022

View full text Add to dashboard Cite

IntroductionAutologous (ABR) and implant-based breast reconstruction (IBR) represent the most common procedures after skin- and nipple-sparing mastectomy. This cross-sectional study is a comprehensive analysis of ABR and IBR considering surgical and patient-reported outcomes.Patients and methodsEligible patients underwent breast reconstruction (ABR and IBR) after skin- and nipple-sparing mastectomy between January 2014 and December 2020. Outcome parameters included quality of life (European Organisation for Research and Treatment of Cancer - EORTC - QLQ30, BR23, Breast-Q, CES-D), complication rates, aesthetic result, and breast sensitivity.Results108 patients participated in the study (IBR: n = 72, age 48.9 ± 9.9 years; ABR: n = 36, age: 46.6 ± 7.3 years). Mean follow-up was 27.1 ± 9.3 (IBR) and 34.9 ± 20.5 (ABR), respectively. IBR patients suffered significantly more often from major complications (30.6% vs. 8.3%; p = 0.01), while ABR patients underwent secondary procedures significantly more often to improve the aesthetic result (55.6% vs. 29.2%, p = 0.004). Unilateral reconstructions revealed superior aesthetic results in ABR (n.s.), while in bilateral reconstruction IBR tended to score higher (n.s.). Scar evaluation resulted in a better result of IBR in both categories (p < 0.01). Breast sensitivity was severely impaired in both groups. The Breast-Q revealed a significantly higher “patient satisfaction with breast” after ABR (p = 0.033), while the other QoL-tests and subscales showed no significant differences between the two procedures.ConclusionABR is associated with a higher patient satisfaction despite the high probability of secondary procedures to improve the aesthetic outcome, whereas IBR-patients suffer more often from major complications. Furthermore, the laterality of reconstruction should be included in the individual decision-making process.

show abstract

Implant-based Breast Reconstruction after Mastectomy for Breast Cancer: A Systematic Review and Meta-analysis

Cited by 18 publications

References 70 publications

Implant-based versus Autologous Reconstruction after Mastectomy for Breast Cancer: A Systematic Review and Meta-analysis

Implant-based versus Autologous Reconstruction after Mastectomy for Breast Cancer: A Systematic Review and Meta-analysis

Autologous Breast Reconstruction after Mastectomy for Breast Cancer: A Systematic Review

Autologous vs. implant-based breast reconstruction after skin- and nipple-sparing mastectomy—A deeper insight considering surgical and patient-reported outcomes

Contact Info

Product

Resources

About