Safety of prepectoral breast reconstruction after mastectomies: a single-arm meta-analysis

Abstract

Aim: Currently, prepectoral breast reconstruction (PBR) is widely used in clinical practice, but its safety lacks high-level epidemiological evidence. This meta-analysis intended to clarify the safety of PBR for clinicians.

Methods: The study followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Two independent reviewers systematically searched six databases from 1 January 2000 to 27 March 2020 to identify eligible studies. Statistical analysis was performed using R GUI 3.6.3, and a random effects model was used to calculate the proportion with 95% confidence intervals (CIs). Subgroup analysis was conducted based on body mass index, proportion of patients receiving preoperative radiotherapy, surgical technique, and follow-up time.

Results: In total, 19 studies involving 1686 cases and 2551 breasts were included. The percentage of surgical success was 96.2%, while the total complication rate was 15.4% (95%CI: 10.6%-20.9%), hematoma rate was 4.3% (95%CI: 2.3%-6.9%), infection rate was 3.4% (95%CI: 2.0%-5.1%), and capsular contracture rate was 0.9% (95%CI: 0.1%-2.6%). The results of the subgroup analysis show that: (1) the incidence of capsular contracture was higher in patients with lower weight, while other complications were minimal; (2) compared with the patients who underwent two-stage expander-assisted PBR, those with direct to-implant PBR had lower incidences of surgical complications; (3) preoperative radiotherapy could be a risk factor for various postoperative complications; and (4) with the extension of follow-up time, the incidence of long-term complications increases.

Conclusion: This present work confirmed that PBR is a safe and reliable therapy with a higher success rate and a relatively lower rate of complications. Overall, PBR can be used as an alternative for sub-pectoral breast reconstruction.

Keywords

Prepectoral breast reconstruction / after mastectomies / single-arm meta-analysis

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