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

Abstract

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.

The Impact of Travel Distance and Income on Breast Reconstruction after Mastectomy in a Rural Population

“…The previously reported rates of postmastectomy reconstruction in the United States have been 19% autologous and 81% implant-based reconstruction, with 68% undergoing two-stage allogenic reconstruction, and 13% undergoing one-stage (direct-to-implant) reconstruction, which is comparable to our data. 24 Overall rates of complications were also similar to previous studies of breast reconstruction after mastectomy. 17,18,25 National and statewide studies had previously demonstrated that greater travel distance had a negative impact on the rate of breast reconstruction after mastectomy, with patients who underwent reconstruction traveling father than those who did not, especially to academic institutions.…”

“…Approximately half (52.6%) of all mastectomy patients underwent breast reconstruction, which is comparable to previous literature demonstrating a postmastectomy reconstruction rate of 40%. 4,[21][22][23][24] Most of the patients who underwent reconstruction had immediate two-stage allogenic reconstruction, with 23.9% of patients undergoing autologous reconstruction. The previously reported rates of postmastectomy reconstruction in the United States have been 19% autologous and 81% implant-based reconstruction, with 68% undergoing two-stage allogenic reconstruction, and 13% undergoing one-stage (direct-to-implant) reconstruction, which is comparable to our data.…”

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

“…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. Here, we evaluate the comparative benefits and harms of (1) timing of AR relative to chemotherapy and radiation therapy, and (2) various flap types for AR.…”

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

“…Thanks to the development of the Breast-Q, patient-reported outcomes in breast reconstruction have widely been explored, while the health-related quality of life (HRQoL) and symptoms of depression have been neglected (8,9). Studies giving a comprehensive overview of further clinical and surgical outcome parameters such as complication rates, aesthetic outcome, and breast sensibility of both procedures are lacking (8,(10)(11)(12). Furthermore, most studies do not include a homogenous patient collective with regard to the type of mastectomy (6,10), which makes the interpretation of the study results difficult (8).…”