Pectoral Fascia Preservation in Oncological Mastectomy to Reduce Complications and Improve Reconstructions: A Systematic Review

Abstract

Background: Excision of the pectoral fascia (PF) is routinely performed in oncological mastectomies. Preservation of the PF may, however, decrease postoperative complication rates for bleeding, infections, and seroma. It may also improve reconstructive outcomes by better prosthesis coverage, thereby reducing implant extrusion rates and improving cosmetic outcomes. Methods: A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis principles was performed. Studies describing PF preservation were searched in 3 databases. All studies including more than 10 patients were included. The main outcomes were oncological safety (local recurrence, regional and distant metastases, and mortality rates), complication rates (bleeding, infections, seroma), loss of the prosthesis after reconstructive surgery, and cosmetic outcomes following reconstruction. Results: Five studies were included. Three reported on 2 different randomized controlled trials (n = 73, and n = 244), and 2 studies were retrospective case series (n = 203 and n = 256). PF preservation did not affect oncological outcomes in terms of local recurrences, regional and distant metastases, or mortality rates. One study described a significantly lower incidence of seroma in the PF preservation group. No differences were found for bleeding complications and infections. No objective data were provided for reconstructive complications or cosmetic outcomes. Conclusions: The literature on PF preservation is scarce. Based on the current evidence, PF preservation seems oncologically safe while potentially reducing postoperative complication rates. It is expected that reconstructive outcomes will benefit from PF preservation, but these studies lack evidence on this topic. Future studies should provide insight into all aspects of PF preservation.

Implant Loss and Associated Risk Factors following Implant-based Breast Reconstructions

“…It may also decrease seroma formation, postoperative bleeding, and postoperative pain. 19 The incidence of implant extrusion in mastectomies with pectoral fascia preservation varies in the literature-from 0.9% to 1.6% 20,21 -which is substantially lower than the incidence of implant loss in our study. However, current evidence on this topic is limited.…”

Bilateral prophylactic mastectomy: should we preserve the pectoral fascia? Protocol of a Dutch double blinded, prospective, randomised controlled pilot study with a within-subject design (PROFAS)

“…These results have been summarised and described in a recently published systematic review. 14 Of the five included articles, three studies investigated oncological outcomes after PF preservation. In conclusion, there were no significant differences in chest wall and (loco)regional recurrences or distant metastasis, along with similar mortality rates.…”

Re-alignment of Clavipectoral Fascia for Axillary Web Syndrome Prevention, an Egyptian Multi-Center RCT

“…CPF excision is widely performed in modified radical mastectomy and conservative mastectomy, yet the importance of its excision is still unclear. 28 From embryological point of view, CPF is a part of the muscular anatomy not the glandular tissue of the breast. Furthermore, intraoperatively, the fascia is closely adherent to the pectoralis major muscle (PMM), with no separating epimysium.…”