Implant vs. autologous tissue-based breast reconstruction: A systematic review and meta-analysis of the studies comparing surgical approaches in 55,455 patients

Stefura, Tomasz; Rusinek, Jakub; Wątor, Julia; Zagórski, Adrian; Zając, Maciej; Libondi, Guido; Wysocki, Wojciech M.; Koziej, Mateusz

doi:10.1016/j.bjps.2022.11.044

Cited by 29 publications

(30 citation statements)

References 57 publications

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“…These differences in complication rates are in line with literature regarding the respective approaches and representative of reported comparisons. 1,2,16,44,46,47…”

Section: Discussionmentioning

confidence: 99%

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An Interdisciplinary, Comprehensive Recovery Pathway Improves Microsurgical Breast Reconstruction Delivery

Clark,

Segal,

Kordahi

et al. 2024

Ann Plast Surg

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Introduction Free-flap (autologous) breast reconstruction demonstrates superiority over alloplastic approaches but is offered infrequently. Enhanced recovery protocols can address postoperative challenges, but most literature is limited to inpatient interventions and outcomes. This study describes an adoptable, longitudinally comprehensive and multidisciplinary recovery pathway for autologous reconstruction which adds to the current guidelines. The authors aimed to allow perioperative outcomes comparable to alloplastic reconstructions. Methods All autologous Comprehensive Recovery Pathway (CRP) subjects from a single surgeon were retrospectively included. A comparator group of equal size was randomly selected from institutional subpectoral and dual-plane tissue expander patients having Enhanced Recovery After Surgery guideline–directed care. All subjects in both cohorts received preoperative paravertebral regional blocks. Operative detail, inpatient recovery, longitudinal morphine equivalents (MEs) required, and complications were compared. Results Each cohort included 71 cases (99 breasts). Despite longer operations, intraoperative MEs were fewer in autologous cases (P = 0.02). Morphine equivalents during inpatient stay were similar between cohorts, with both being discharged on median day 2. Multivariate regression demonstrated a 0.8-day increased stay for autologous subjects with additional contribution from bilateral cases, body mass index, and age (P < 0.05). Autologous subjects were regularly discharged postoperative day 1 (17%) and postoperative day 2 (39%), with trend toward earlier discharge (P < 0.01). Outpatient MEs were significantly fewer in autologous subjects, corresponding to a 30- to 150-mg oxycodone difference (P < 0.01). Major complication occurred in 12.7% of autologous and 22.5% of alloplastic subjects (P = 0.11). Flap loss occurred in 1 autologous subject versus 11 alloplastic failures (P < 0.01). Conclusions This study details partnership between the plastic surgery service, regional and acute pain anesthesia services, and dedicated nursing with longitudinal optimizations allowing perioperative outcomes improved over current literature. Patients in the CRP used fewer opioids from operation through follow-up with comparable length of stay and significantly fewer reconstructive failures than alloplastic subjects. The pathway may be quickly adopted into academic practice patterns and mitigates traditional barriers, allowing extension of autologous reconstruction offerings.

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“…These differences in complication rates are in line with literature regarding the respective approaches and representative of reported comparisons. 1,2,16,44,46,47…”

Section: Discussionmentioning

confidence: 99%

“…Meanwhile, discharge of IBR patients before day 3 is commonplace. [14][15][16][17][18][19] These challenges make adoption and widespread offering of autologous reconstruction difficult.…”

mentioning

confidence: 99%

An Interdisciplinary, Comprehensive Recovery Pathway Improves Microsurgical Breast Reconstruction Delivery

Clark,

Segal,

Kordahi

et al. 2024

Ann Plast Surg

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“…ABR carries a higher risk of skin necrosis, excessive scarring, and wound dehiscence, while IBR is more vulnerable to issues, such as infections, seromas, capsular contractures, and hematomas. 6 Despite the widespread acceptance of breast reconstruction, it remains an elective procedure. While immediate reconstruction postmastectomy is available, a significant majority of patients (80%) choose delayed reconstruction, which can take place months or even years following the mastectomy.…”

Section: Introductionmentioning

confidence: 99%

“…However, each method comes with its own sets of potential complications. ABR carries a higher risk of skin necrosis, excessive scarring, and wound dehiscence, while IBR is more vulnerable to issues, such as infections, seromas, capsular contractures, and hematomas 6 . Despite the widespread acceptance of breast reconstruction, it remains an elective procedure.…”

Section: Introductionmentioning

confidence: 99%

In hospital outcomes of autologous and implant‐based breast reconstruction in patients with diabetes mellitus: A population‐based study of 2015–2020 national inpatient sample

Li,

Ranganath

2024

World j. surg.

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BackgroundBreast reconstruction encompasses autologous (ABR) and implant‐based breast reconstruction (IBR) each with its own sets of potential complications. Diabetes mellitus (DM) is associated with breast reconstruction complications, although most of the studies did not differentiate between the reconstruction procedures. This study conducted a population‐based study examining impact of DM on inhospital outcomes in ABR and IBR.MethodsPatients underwent ABR or IBR were identified in National Inpatient Sample from Q4 2015 to 2020. A 1:2 propensity score matching was used to address differences in demographics, hospital characteristics, primary payer status, comorbidities, and reconstruction staging between DM and non‐DM patients. In hospital outcomes were assessed separately in ABR and IBR.ResultsThere were 997 (7.68%) DM and 11,987 (92.32%) non‐DM patients in ABR. Meanwhile, 1325 (7.38%) DM and 16,638 (92.62%) non‐DM patients underwent IBR. DM cohorts in ABR and IBR were matched to 1930 and 2558 non‐DM patients, respectively. After matching, DM patients in both ABR and IBR had higher risks of renal complications (ABR, 3.73% vs. 1.76%, p < 0.01; IBR, 1.83% vs. 0.78%, p = 0.01) and longer length of stay (ABR, p = 0.01; IBR, p = 0.04). In ABR, DM patients had higher respiratory complications (2.82% vs. 1.19%, p < 0.01), excessive scarring (2.72% vs. 1.55%, p = 0.03), and infection (2.42% vs. 1.14%, p = 0.01), while in IBR, DM patients had higher hemorrhage/hematoma (5.40% vs. 3.40%, p < 0.01) and transfer out (1.52% vs. 0.78%, p = 0.04).ConclusionDM was associated with distinct sets of inhospital complications in ABR and IBR, which can be valuable for preoperative risk stratification and informing clinical decision‐making for DM patients.

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“…Accordingly, conducting NACT followed by total mastectomy and immediate reconstruction has become an important treatment strategy with increasing popularity. 7 However, considering the potentially negative impact of chemotherapy on wound healing 8 and the relatively higher risks of developing postoperative complications after immediate reconstruction, 9 concerns have been raised as to whether conducting NACT could have a negative influence on the outcomes of immediate reconstruction. Although several studies investigated this, inconsistent results have been presented; thus, this topic remains uncertain 1,10,11 and even more complicated when it comes to immediate breast reconstruction using prepectoral space after NACT.…”

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confidence: 99%

Association of Neoadjuvant Chemotherapy With Postoperative Outcomes in Immediate Prepectoral Prosthetic Breast Reconstruction

Choi,

Lee,

Pyon

et al. 2024

Ann Plast Surg

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Purpose Neoadjuvant chemotherapy (NACT) followed by total mastectomy and immediate reconstruction has become an important strategy in the treatment of breast cancer. Although the safety of subpectoral implant-based breast reconstruction with NACT has been extensively evaluated, the safety in prepectoral reconstruction has not been clearly elucidated. We aimed to evaluate the association of NACT with immediate prepectoral breast reconstruction outcomes. Methods A retrospective review of patients who underwent total mastectomy and immediate implant-based prepectoral breast reconstruction between May and December 2021 was conducted. Patients were categorized into 2 groups: those receiving NACT and those not receiving it. Postoperative complication rates were compared between the 2 groups. The independent association between NACT and the complication profiles was evaluated. Propensity score matching was also conducted. Results We analyzed 343 cases, including 85 who received NACT treatment and 258 who did not. Compared with the non-NACT group, the NACT group was younger, had a higher body mass index, and a higher rate of adjuvant radiotherapy. There were no differences in the rates of overall complications or type of complication between the 2 groups. In the multivariable logistic analyses, NACT did not show a significant association with the development of adverse outcomes. Similar results were observed in propensity score matching analyses. Conclusions Our results suggest that receiving NACT may not have a significant detrimental effect on the postoperative outcomes of immediate prepectoral prosthetic reconstructions. Conducting prepectoral implant-based reconstruction in the setting of NACT might be safe and provide acceptable outcomes.

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Implant vs. autologous tissue-based breast reconstruction: A systematic review and meta-analysis of the studies comparing surgical approaches in 55,455 patients

Cited by 29 publications

References 57 publications

An Interdisciplinary, Comprehensive Recovery Pathway Improves Microsurgical Breast Reconstruction Delivery

An Interdisciplinary, Comprehensive Recovery Pathway Improves Microsurgical Breast Reconstruction Delivery

In hospital outcomes of autologous and implant‐based breast reconstruction in patients with diabetes mellitus: A population‐based study of 2015–2020 national inpatient sample

Association of Neoadjuvant Chemotherapy With Postoperative Outcomes in Immediate Prepectoral Prosthetic Breast Reconstruction

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