Does Prior Breast Irradiation Increase Complications of Subsequent Reduction Surgery in Breast Cancer Patients? A systematic Review and Meta-Analysis

George Pappas; William Karantanis; Femi E Ayeni; Senarath Edirimanne

doi:10.1007/s00266-024-04038-6

Does Prior Breast Irradiation Increase Complications of Subsequent Reduction Surgery in Breast Cancer Patients? A systematic Review and Meta-Analysis

Aesthetic Plast Surg. 2024 Apr 24. doi: 10.1007/s00266-024-04038-6. Online ahead of print.

Authors

George Pappas¹, William Karantanis^{1

2}, Femi E Ayeni³, Senarath Edirimanne^{1

4}

Affiliations

¹ Department of Surgery, Nepean Hospital, Derby Street, Kingswood, NSW, 2747, Australia.
² Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia.
³ Nepean Institute of Academic Surgery, Nepean Clinical School, The University of Sydney, 62 Derby Street, Kingswood, NSW, 2747, Australia. femi.ayeni@sydney.edu.au.
⁴ Nepean Institute of Academic Surgery, Nepean Clinical School, The University of Sydney, 62 Derby Street, Kingswood, NSW, 2747, Australia.

PMID: 38658406
DOI: 10.1007/s00266-024-04038-6

Abstract

Background: Reduction mammoplasty and mastopexy are potentially complicated by prior breast irradiation as part of breast conserving therapy. Associated tissue changes with therapeutic irradiation have led to surgeons deciding the risks may outweigh potential benefit for those patients. A systematic review of the existing literature was performed to explore surgical outcomes of patients undergoing delayed bilateral reduction mammoplasty or mastopexy following unilateral breast irradiation as part of breast conserving therapy.

Methods: Medline, PubMed and EMBASE were searched from 1990 to 2023 according to PRISMA guidelines. Studies were combined by the generic inverse variance method on the natural logarithms of rate ratios (RR) using a random effect model in Review manager 5.4.1.

Results: Fifteen studies reported outcomes in 188 patients who underwent breast reduction (BR) following unilateral breast conserving surgery and radiotherapy. The median age at BR was 51.5 years (range 39-60), and median time since radiotherapy was 48 months (range 11.7-86). We compared outcomes for irradiated breast (IB) versus non-irradiated breast (NIB). Pooled results showed higher rate of major complications in the IB (RR 2.52, 95%CI 0.96-6.63, p=0.06), but not statistically significant. However, rate of minor complications was significantly higher in the IB (RR 3.97 95%CI 1.86-8.50, p<0.0004). Incidence of fat necrosis as a discrete complication was 2× higher in IB (RR 2.14 95%CI 0.85-5.35, p-value 0.10) compared to the NIB, but not significant.

Conclusion: We found breast reduction to be safe with acceptable risk of major complications. However, the overall complication rate remains higher in IB compared to NIB.

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 .

Keywords: Breast irradiation; Complications; Mastopexy; Reduction mammoplasty.

Publication types

Review