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Hyperbaric Oxygen Therapy for Ischemic Complications and Salvage Following Breast Reconstruction: A Systematic Review
Guilherme Franceschini Machado1, Jonathan Mokhtar2, Victoria Trasatti Romão3
1Hospital San Paolo, São Paulo, Brazil.
Background:
Ischemic complications following breast reconstruction remain a significant cause of morbidity. Hyperbaric oxygen therapy (HBOT) is increasingly used as an adjunctive modality to enhance perfusion and salvage threatened reconstructions, yet its therapeutic benefit in this setting remains unclear. This study aims to compare ischemic complications following reconstructive breast surgery in patients receiving HBOT versus non-HBOT therapies.
Methods:
A systematic review and meta-analysis was conducted following PRISMA guidelines. PubMed, Embase, and CENTRAL were searched from inception to July 2025. Studies evaluating HBOT for postoperative ischemic complications following breast reconstruction were included. Comparative outcomes were synthesized using random-effects models, and single-arm outcomes were pooled using random-effects meta-analysis of proportions. Risk of bias was assessed with ROBINS-I, and the certainty of evidence was evaluated with GRADE.
Results:
Of the 1721 records, seven studies met the inclusion criteria. HBOT did not significantly reduce hematoma (OR 2.92; 95% CI [0.47-18.06]; p = 0.25), skin necrosis (OR 4.72; 95% CI [0.13-172.44]; p = 0.40), or reoperation (OR 2.42; 95% CI [0.89-6.55]; p = 0.08). Single-arm HBOT cohorts demonstrated pooled rates of seroma (16.1%), SSI (18.8%), return to the operating room for debridement (12.6%), and explantation (21.6%).
Conclusions:
Across seven non-randomized studies, comparative evidence for HBOT versus standard care in ischemic complications after breast reconstruction is insufficient and inconclusive to determine whether HBOT reduces ischemic complications. HBOT may be considered selectively within protocolized multidisciplinary pathways, but stronger prospective comparative studies with standardized indications and outcome definitions are needed to clarify its role.
Level Of Evidence Iii:
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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