Reconstructive Strategies After Mastectomy: Comparative Outcomes, PMRT Effects, and Emerging Innovations

Area of Science:

• Oncologic surgery
• Plastic and reconstructive surgery
• Breast cancer treatment

Background:

• Breast reconstruction is integral to modern oncologic care, enhancing quality of life post-mastectomy.
• Surgeons face a dilemma choosing between implant-based reconstruction (IBR) and autologous reconstruction (ABR), especially with planned postmastectomy radiotherapy (PMRT).

Purpose of the Study:

• To compare outcomes of IBR versus ABR in patients undergoing mastectomy, focusing on the impact of PMRT.
• To evaluate reconstructive success, complications, and patient-reported satisfaction across different techniques.

Main Methods:

• Systematic review of studies from 2014-2024, including observational cohorts and meta-analyses (over 60,000 breasts).
• Analysis of surgical complications, reconstructive failure, patient-reported outcomes (BREAST-Q), and PMRT effects.
• Consideration of innovations like prepectoral implants and robotic-assisted autologous procedures.

Main Results:

• Autologous reconstruction yielded higher patient satisfaction and psychosocial/sexual well-being, particularly with PMRT.
• Implant-based reconstruction offered faster recovery but higher rates of capsular contracture and failure post-irradiation.
• Reconstruction, regardless of timing, did not negatively impact local recurrence or overall survival when adjuvant therapy was timely.

Conclusions:

• Both IBR and ABR are oncologically safe and vital for recovery after mastectomy.
• Future advancements lie in integrating surgical precision with technologies like prepectoral implants and robotic flap harvesting for patient-centered results.