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

Background and Objectives The present review evaluated the impacts of pre-reconstruction radiotherapy on outcome of prosthetic breast reconstruction and compared the safety of prosthetic reconstruction with that of other modalities, including autologous tissue reconstruction and the combination of flap and implant in the setting of pre-reconstruction radiation. Methods Studies presenting outcomes of prosthetic breast reconstruction in the setting of pre-reconstruction radiation published in the past 10 years were identified and reviewed. Results Twenty studies were analyzed. Prosthetic reconstruction in previously irradiated breasts showed significantly increased risks for complications, including reconstruction failure (relative risk, 2.58; 95% confidence interval, 1.86-3.57) than those cases without radiation, regardless of the specific surgical technique used, including one-/two-stage reconstruction, use of an acellular dermal matrix or not, and the timing of the reconstruction (immediate/delayed). Autologous tissue reconstruction and a combination flap and implant showed a 92% and 72% decreased risk of reconstruction failure, respectively, in previously irradiated breasts compared with that of prosthetic reconstruction. Conclusions 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.