Chest Wall Perforator Flaps in Partial Breast Reconstruction: A Systematic Review and Meta-analysis

Breast-conserving surgery with radiotherapy is the standard treatment for early-stage management of breast cancer but may cause volume loss. In such cases, muscle-sparing chest wall perforator flaps (CWPFs) offer a reliable, function-preserving reconstruction option with low donor-site morbidity, making them particularly useful for volume replacement. This systematic review and meta-analysis evaluated the outcomes and complications of CWPFs in breast-conserving surgery.

A systematic literature review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles reporting postoperative outcomes and complications following partial breast reconstruction using CWPFs were included. A proportional meta-analysis was then performed to calculate pooled complication rates and 95% confidence intervals (95% CIs).

Seventeen studies, involving 1893 unilateral CWPFs, were included. The rate of recipient-site complications was 13% (95% CI: 7%-20%), and the flap loss rate was 1% (95% CI: 0%-3%). Reexcision and completion mastectomy rates were 12.9% and 1.46%, respectively. Patient satisfaction was consistently high, assessed using a 4-point Likert scale (n = 3), BREAST-Q (n = 2), or author-designed questionnaires (n = 2). Surgeon and independent reviewer assessments also indicated favorable aesthetic results but lacked standardization across studies.

This meta-analysis synthesized all existing evidence on CWPFs for partial breast reconstruction across all breast quadrants. The 1893 flaps reviewed showed consistently favorable outcomes, broad applicability based on tumor location, and low complication rates. CWPFs seem to be an ideal option for partial breast reconstruction in patients with small breasts and large defects.