ReviewUptake and predictors of post-mastectomy reconstruction in women with breast malignancy – Systematic review
Section snippets
Background
There is evidence showing that breast reconstruction is a safe option for the majority of women undergoing mastectomy for breast cancer and that it does not have an adverse effect on rates of recurrence.1, 2 There is some evidence of quality of life benefits of immediate over delayed breast reconstruction,3, 4 although this finding has not been consistent.5 There is very little research comparing outcomes in women who undergo reconstruction and those who choose not to. A prospective study found
Methods
Studies were identified by searching Medline (Pubmed and Ovid) and the Cochrane Database using the search terms ‘breast cancer,’ ‘breast reconstruction,’ and ‘mastectomy.’ The search was limited to studies in English published from January 1980 to December 2011. Additional studies were identified by reviewing the references of eligible studies.
Eligibility criteria were: original study reporting outcomes for at least 25 women with early breast malignancy (invasive or in situ) AND reporting rate
Study selection
The search identified 182 studies; a further 15 studies were added after review of reference lists of eligible studies. Fifty two abstracts met eligibility criteria and 24 were excluded following review of full text articles (Fig. 1).24 Twenty eight studies were eligible for inclusion in the analysis (Fig. 1).11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39
Study characteristics
Included studies are shown in Table 1 (ordered by number of mastectomy cases
Discussion
Enormous variation in rates of breast reconstruction (4·9 to 81·2%) was seen and there are no clear trends to explain this. While there are higher rates of reconstruction in more recent years, the incremental increase is extremely small in most studies.11, 13, 14, 23, 38 The exception is the series of robust audits in the UK that show a large increase in a short period of time. This is the only series to show a significant increase over time, despite the dramatic improvements in technical
Conclusion
In conclusion, rates of breast reconstruction are generally low and highly variable. Studies of breast reconstruction rates have been inconsistent in their methodology, in the type of reconstruction examined (immediate or delayed) and in the variables they assessed. Due to this heterogeneity, it is difficult to draw firm conclusions from the data. The reasons for the variable rate are unclear but appear to be complex and multifactorial. Surgeon, institution, geographical and access issues are
Funding
This research is funded in part by The Friends of the Mater Foundation, North Sydney, Australia, supporting part of A/Prof Spillane's research time.
The funding source played no role in study design, data collection, analysis and interpretation of data, writing of the manuscript or decision to submit the manuscript for publication.
Conflicts of interest
The authors have no conflicts to declare.
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2020, European Journal of Surgical OncologyCitation Excerpt :When surgeons introduce different reconstruction techniques, it is acceptable and somewhat inevitable for pTRAM and DIEP to have a learning curve during the pioneering period [19]. Other results revealed that hospitals with a larger clinical breast department may extensively collaborate with a plastic surgery department, which could result in a higher breast reconstruction rate [20,21]. The breast surgical volume was associated with performing autologous reconstruction (including LDF and pTRAM, p < 0.05).