Breast reconstruction and adjuvant therapy: A systematic review of surgical outcomes

Background and Objectives: The impact of adjuvant therapy on the surgical outcomes following breast reconstruction is poorly understood. The purpose of this systematic review was to evaluate surgical outcomes following autologous and prosthetic reconstruction in the setting of post-mastectomy radiation therapy (PMRT) and adjuvant chemotherapy. Methods: A systematic review of the English literature published from 2000 to 2015 in the Pubmed/MEDLINE database was performed to identify all manuscripts reporting outcome of breast reconstruction in patients receiving PMRT and/or adjuvant chemotherapy. Results: Sixty-two manuscripts met the criteria for inclusion. This included 56 manuscripts (5437 patients) evaluating patients treated with PMRT and 11 manuscripts (820 patients) evaluating patients treated with chemotherapy. Pooled analysis of the PMRT cohort revealed significantly higher weighted incidences of re-operation (P < 0.0001), total complications (P < 0.0001), and reconstructive failure (P < 0.0001) in prosthetic reconstruction compared to autologous. There was little evidence to suggest that postoperative chemotherapy is associated with poorer overall outcomes. Conclusions: PMRT was associated with an increased incidence of adverse events when compared to chemotherapy. There was little evidence to suggest that adverse events following breast reconstruction were related to adjuvant chemotherapy. Manipulating the method and timing of reconstruction may mitigate some of the undesirable outcomes associated with PMRT.