Complications of Prosthetic Breast Reconstruction in Prophylactic Versus Therapeutic Mastectomy: A Systematic Review...

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).

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).

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.

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.