The Impact of Postmastectomy Radiation Therapy on the Outcomes of Prepectoral Implant-Based Breast Reconstruction: A Systematic Review and Meta-Analysis

Abstract

Background Breast reconstruction is the mainstay treatment choice for patients subjected to a mastectomy. Prepectoral implant-based breast reconstruction (IBBR) is deemed to be a promising alternative to subpectoral reconstruction. Postmastectomy radiation therapy (PMRT) is necessary for locoregional recurrence control and to improve the disease-free survival rate in locally advanced breast cancer. This systematic review and meta-analysis study was designed to reveal the surgical, aesthetic, and oncological outcomes of prepectoral IBBR after PMRT. Methods An extensive literature search was performed from inception to March 28, 2022. All clinical studies that included patients who were subjected to prepectoral IBBR and PMRT were included. Studies that included patients who received radiation therapy before prepectoral IBBR were excluded. Results This systematic review included six articles encompassing 1234 reconstructed breasts. Of them, 391 breasts were subjected to PMRT, while 843 breasts were not subjected. Irradiated breasts were more susceptible to develop wound infection (RR 2.49; 95% 1.43, 4.35; P = 0.001) and capsular contracture (RR 5.17; 95% 1.93, 13.80; P = 0.001) than the non-irradiated breasts. Furthermore, irradiated breasts were more vulnerable to losing implants (RR 2.89; 95% 1.30, 6.39; P = 0.009) than the non-irradiated breast. There was no significant difference between both groups regarding the risk of implant extrusion (RR 1.88; 95% 0.20, 17.63; P = 0.58). Conclusions Patients with prepectorally IBBR and PMRT were more vulnerable to developing poor outcomes. This included a higher risk of breast-related and implant-related adverse events. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Ptotic versus Nonptotic Breasts in Nipple-sparing Mastectomy and Immediate Prepectoral Breast Reconstruction

“…These results are consistent with previous studies. 12,31 Despite the advantages of prepectoral IBBR, we should be careful in selecting patients who are candidates for PMRT.…”

Predicted factors of surgical site infection in glioblastoma patients: A meta‐analysis

“…Irradiation has been epidemiologically correlated with higher risk of wound infections after surgery or chronic infections 1,14–16 . Whereas it has not been determined that radiation therapy as an independent risk factor for SSIs in after surgery in glioma 11,16,17 .…”

Current Global Trends in Prepectoral Breast Reconstruction

“…Radiation therapy is an imperative requirement for approximately 40% of patients who have undergone mastectomy, as it plays a crucial role in their treatment plan. Post-mastectomy radiation therapy (PMRT) is an indispensable component of this treatment plan, as it serves the purpose of effectively controlling locoregional recurrence and enhancing the rate of disease-free survival for patients with locally advanced breast cancer [ 47 , 48 , 49 ]. However, it is important to acknowledge that despite the therapeutic benefits of PMRT, its implementation may result in profoundly adverse effects within the context of implant-based reconstruction.…”

“…However, it is important to acknowledge that despite the therapeutic benefits of PMRT, its implementation may result in profoundly adverse effects within the context of implant-based reconstruction. This is primarily because PMRT leads to a reduction in both the quantity and quality of microvascular blood flow to the breast, which in turn has detrimental effects on the integrity of the skin flaps and the overall condition of the breast tissue [ 47 , 50 , 51 ]. Consequently, patients may experience radiation-induced damage that becomes evident within a few days to weeks after treatment, manifesting as edema, inflammation, and desquamation on the skin and tissue of the breast.…”