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

Area of Science:

• Oncology
• Plastic Surgery
• Evidence-Based Medicine

Background:

• Breast reconstruction is crucial for cancer survivors' quality of life.
• Uncertainty exists regarding optimal techniques, timing, and implant choices.
• This review informs updated clinical practice guidelines.

Purpose of the Study:

• To systematically review evidence on breast reconstruction after mastectomy.
• To address key areas including mastectomy type, reconstruction timing, implant placement, and adjunct therapies.
• To provide an evidence base for updated clinical practice guidelines.

Main Methods:

• Systematic review of Medline, Embase, and Cochrane databases.
• Inclusion of 229 primary studies, predominantly retrospective comparative studies and 5 RCTs.
• Protocol registered on PROSPERO (CRD42023409083).

Main Results:

• Nipple-sparing mastectomy is oncologically safe when the nipple-areolar complex is uninvolved.
• Immediate reconstruction offers better short-to-medium term quality of life than delayed.
• Prepectoral implants may reduce long-term complications compared to subpectoral.
• Autologous fat grafting is oncologically safe and improves aesthetics.

Conclusions:

• Nipple-sparing mastectomy and immediate reconstruction are viable options with oncological safety.
• Prepectoral implant placement and autologous fat grafting show promise for improved outcomes.
• Evidence supports delaying reconstruction post-radiotherapy by at least 3-6 months.