Complications of Prosthetic Breast Reconstruction in Prophylactic Versus Therapeutic Mastectomy: A Systematic Review and Meta-analysis.

Abstract

Background: 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).

Methods: 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).

Results: 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.

Conclusions: 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.