Comparison of prepectoral and subpectoral breast reconstruction after mastectomies: A systematic review and meta analysis

Lun Li; Yonghui Su; Bingqiu Xiu; Xiaoyan Huang; Weiru Chi; Jianjing Hou; Yingying Zhang; Jinhui Tian; Jia Wang; Jiong Wu

doi:10.1016/j.ejso.2019.05.015

Comparison of prepectoral and subpectoral breast reconstruction after mastectomies: A systematic review and meta analysis

Eur J Surg Oncol. 2019 Sep;45(9):1542-1550. doi: 10.1016/j.ejso.2019.05.015. Epub 2019 May 14.

Authors

Lun Li¹, Yonghui Su¹, Bingqiu Xiu¹, Xiaoyan Huang¹, Weiru Chi¹, Jianjing Hou¹, Yingying Zhang¹, Jinhui Tian², Jia Wang¹, Jiong Wu³

Affiliations

¹ Department of Breast Surgery, Shanghai Cancer Center, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Collaborative Innovation Center for Cancer Medicine, Shanghai, China.
² Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China.
³ Department of Breast Surgery, Shanghai Cancer Center, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Collaborative Innovation Center for Cancer Medicine, Shanghai, China. Electronic address: wujiong1122@vip.sina.com.

PMID: 31256950
DOI: 10.1016/j.ejso.2019.05.015

Abstract

Background: The safety of prepectoral breast reconstruction (PBR) after mastectomies as compared to subpectoral breast reconstruction (SBR) were unclear, so we conducted a systematic review to analyze their differences.

Methods: PubMed, EMBASE, the Cochrane Library, and Web of Science databases were searched to retrieve studies that compared PBR with SBR after mastectomies. The outcomes were complications, oncological safety, patient-reported outcomes and postoperative pain. Revman software version 5.30 and stata vesion 12 was used to conduct meta-analysis where possible.

Results: 16 comparative studies (12 articles and four abstracts) were included. The meta analysis showed no statistical differences in overall complications, implant loss, seroma, nipple or skin flap necrosis, hematoma, reoperation, wound dehiscence, and wound-skin infection, rippling between PBR and SBR. PBR might be associated with fewer nipple or skin flap necrosis for those who received tissue expander placement, and fewer capsular contracture rates for those who received implant. PBR might be associated with better Breast Q scores and less postoperative pain without increasing the risk of local recurrence and metastatic disease.

Conclusion: Although available evidence is limited, PBR might be as safe as subpectoral approach. Future well designed multicenter randomized controlled trial that compare postmastectomy PBR with SBR is needed.

Keywords: Breast cancer; Complication; Mastectomy; Meta-analysis; Prepectoral prosthetic breast reconstruction.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Female
Humans
Mammaplasty / methods*
Mastectomy*
Pain, Postoperative
Patient Reported Outcome Measures
Pectoralis Muscles*