Prosthetic breast reconstruction in previously irradiated breasts: A meta‐analysis

Lee, Kyeong‐Tae; Mun, Goo‐Hyun

doi:10.1002/jso.24032

Cited by 72 publications

(51 citation statements)

References 48 publications

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“…6,14 Furthermore, in patients requiring radiation therapy in addition to mastectomy for breast cancer treatment, autologous reconstruction is associated with higher patient satisfaction and lower complication rates when compared to prosthetic reconstruction. 15 However, despite its many advantages, one of the major challenges with autologous reconstruction is that it is a more invasive procedure compared to prosthetic reconstruction, and therefore associated with increased acute postoperative pain. 16–18 Increased acute postoperative pain is a significant predictor of persistent postsurgical pain, which negatively impacts quality of life and affects nearly 50% of patients with breast cancer.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Paravertebral Block Improves Postoperative Pain Control and Reduces Hospital Length of Stay in Patients Undergoing Autologous Breast Reconstruction after Mastectomy for Breast Cancer

et al. 2016

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Purpose Postoperative pain is a major challenge for patients undergoing breast reconstruction after surgical treatment of breast cancer, resulting in prolonged hospitalizations and additional resource utilization. Evidence on the efficacy of techniques to minimize postoperative pain in autologous breast reconstruction is lacking. The purpose of this study is to determine if preoperative paravertebral block, a regional anesthetic technique, impacts postoperative pain control and length of stay in patients undergoing autologous breast reconstruction. Methods Consecutive patients undergoing postmastectomy autologous breast reconstruction between 2012 and 2015 were identified from a prospectively-collected database to compare those who received PVB to those who did not. Primary outcomes included self-reported pain score, time to oral-only narcotic usage (TTON), and hospital length of stay (LOS). Sample differences were compared using Wilcoxon rank-sum and Chi-squared for continuous and categorical variables. Kaplan-Meier analysis was used to evaluate TTON and LOS, with Mantel-Cox test used to compare groups. Results Of 78 patients, 39 received PVB and 39 did not. Study groups did not differ regarding age, BMI, ASA class, mastectomy type, flap type, or cancer stage (p>0.05). Patients in the PVB group reported significantly lower postoperative pain at 2 (p<0.01) and 24 hours (p<0.01) and shorter median TTON (66 vs. 76 hours, p<0.01). Importantly, median LOS was reduced for patients receiving a PVB in both hours (95 vs. 116, p<0.01) and hospital nights (4 vs. 5, p=0.05). Conclusions Preoperative PVB is associated with improved postoperative pain control and shorter hospitalizations for patients with breast cancer undergoing postmastectomy autologous reconstruction.

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Section: Discussionmentioning

confidence: 99%

Preoperative Paravertebral Block Improves Postoperative Pain Control and Reduces Hospital Length of Stay in Patients Undergoing Autologous Breast Reconstruction after Mastectomy for Breast Cancer

et al. 2016

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“…Unfortunately, prosthetic breast reconstruction after radiation is associated with a high rate of complications and usually results in poor cosmetic outcomes compared with patients without radiation (relative risk, 2.58). 1 – 3 …”

Section: Introductionmentioning

confidence: 99%

Breast Reconstruction Combining Lipofilling and Prepectoral Prosthesis after Radiotherapy

Razzouk

Fitoussi²,

Khori

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Background: Prosthetic reconstruction in previously irradiated breasts has been associated with a higher risk of complications. Here we describe the surgical and cosmetic outcome of our breast reconstruction process based on primary fat grafting combined with prosthetic placement. Methods: In this multicenter retrospective study, 136 patients who underwent mastectomy and external chest wall radiotherapy between 2014 and 2018 were benefited from chest wall lipofilling and silicone implant placement were chosen. Patients were assessed for skin trophicity, thickness, and mobility and were allowed to undergo several lipofilling sessions before implant placement, if required. No patient had >3 lipofilling sessions. Cosmetic outcome was evaluated by the patient, surgeon, and nurse, using a Likert-type ordinal scale. Results: We included 136 patients: 79 patients (58%) received only 1 session of lipofilling before implant placement, 33 (24.6%) had 2 sessions, and 24 (17.4%) had 3 sessions. The volume of the third lipofilling was significantly higher and the volume of the prosthesis of these patients was significantly lower than those of patients undergoing 1 or 2 lipofillings. Reconstruction failure rate was 2.2% (3 patients had explantation); however, all benefited from prosthesis reconstruction a year after the initial procedures. The average satisfaction score was 4.7 out of 5 as evaluated by patients, 4.8 out of 5 by surgeons, and 4.8 out of 5 by nurses. Conclusions: Primary lipofilling combined with prosthesis placement after radiotherapy is a reconstructive method that yields a satisfactory cosmetic outcome with a low complication rate. Such minimally invasive breast reconstruction approach can be an alternative to flap-based reconstruction.

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“…The generic reference to ‘breast reconstruction’ was intended to capture all articles addressing the type and timing of breast reconstruction. Two authors independently reviewed abstracts of all studies published between 1985 and 2014, and the full texts of those studies published in 2015–2017. Levels of clinical evidence (LoE) were evaluated for each publication and scored from I to V by employing Oxford criteria.…”

Section: Methodsmentioning

confidence: 99%

International multidisciplinary expert panel consensus on breast reconstruction and radiotherapy

Nava

Benson

Audretsch

et al. 2019

British Journal of Surgery

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Background Conflicting evidence challenges clinical decision‐making when breast reconstruction is considered in the context of radiotherapy. Current literature was evaluated and key statements on topical issues were generated and discussed by an expert panel at the International Oncoplastic Breast Surgery Meeting in Milan 2017. Methods Studies on radiotherapy and breast reconstruction (1985 to September 2017) were screened using MEDLINE, Embase and CENTRAL. The literature review yielded 30 controversial key questions. A set of key statements was derived and the highest levels of clinical evidence (LoE) for each of these were summarized. Nineteen panellists convened for dedicated discussions at the International Oncoplastic Breast Surgery Meeting to express agreement, disagreement or abstention for the generated key statements. Results The literature review identified 1522 peer‐reviewed publications. A list of 22 key statements was produced, with the highest LoE recorded for each statement. These ranged from II to IV, with most statements (11 of 22, 50 per cent) supported by LoE III. There was full consensus for nine (41 per cent) of the 22 key statements, and more than 75 per cent agreement was reached for half (11 of 22). Conclusion Poor evidence exists on which to base patient‐informed consent. Low‐quality studies are conflicting with wide‐ranging treatment options, precluding expert consensus regarding optimal type and timing of breast reconstruction in the context of radiotherapy. There is a need for high‐quality evidence from prospective registries and randomized trials in this field.

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Prosthetic breast reconstruction in previously irradiated breasts: A meta‐analysis

Abstract: The results suggest that prior irradiation significantly increases the risk of complications in patients undergoing prosthetic reconstruction, and using an autologous flap or combining it with an implant can be considered to reconstruct previously irradiated breasts.

Cited by 72 publications

References 48 publications

Preoperative Paravertebral Block Improves Postoperative Pain Control and Reduces Hospital Length of Stay in Patients Undergoing Autologous Breast Reconstruction after Mastectomy for Breast Cancer

Preoperative Paravertebral Block Improves Postoperative Pain Control and Reduces Hospital Length of Stay in Patients Undergoing Autologous Breast Reconstruction after Mastectomy for Breast Cancer

Breast Reconstruction Combining Lipofilling and Prepectoral Prosthesis after Radiotherapy

International multidisciplinary expert panel consensus on breast reconstruction and radiotherapy

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