Systematic review of partial breast reconstruction with pedicled perforator artery flaps: clinical, oncological and cosmetic outcomes.
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Authors
Pujji, Ojas Jyoti Singh
Vidya, Raghavan
Issue Date
2021-08-01
Journal
Type
Article
Peer-Reviewed Publication
Peer-Reviewed Publication
Keywords
Breast cancer
Breast reconstruction
Chest wall perforator flaps (CWPFs)
Breast neoplasm
Clinical outcomes
Cosmetic outcomes
Oncoplastics
Hematoma
Local neoplasm recurrence
Mammaplasty
Margins of excision
Necrosis
Oncological outcomes
Patient outcomes
Patient satisfaction
Pedicled flap
Peer-reviewed article
Perforator flap
Postoperative complications
Seroma
Systematic review
Surgical flaps
Surgical wound infection
Thoracic wall
Treatment outcome
Breast reconstruction
Chest wall perforator flaps (CWPFs)
Breast neoplasm
Clinical outcomes
Cosmetic outcomes
Oncoplastics
Hematoma
Local neoplasm recurrence
Mammaplasty
Margins of excision
Necrosis
Oncological outcomes
Patient outcomes
Patient satisfaction
Pedicled flap
Peer-reviewed article
Perforator flap
Postoperative complications
Seroma
Systematic review
Surgical flaps
Surgical wound infection
Thoracic wall
Treatment outcome
Journal Title
EJSO - European Journal of Surgical Oncology
Volume
Issue
Begin page
End page
Abstract
The use of chest wall perforator flaps (CWPFs) following breast conservation surgery for breast cancer has become a useful tool in the armamentarium of the oncoplastic breast surgeon, however robust evidence for the technique is lacking. The aim of this study was to conduct a systematic review appraising the current evidence for the use of CWPFs, evaluating clinical, oncological and cosmetic outcomes. A PRISMA-compliant systematic review, with PROSPERO published protocol a priori and search of all relevant database and trial registries between 1990 to July 2020. Eleven studies amounting to 432 cases were reviewed and considered to be at high risk of bias due to small sample size, selective outcome reporting and selection bias. Heterogeneity due to lack of consensus of outcome measures prevented meaningful analysis. Fifty-two (12.3%) clinical complications were recorded: seroma (n = 9; 2.1%), fat necrosis (n = 9; 2.4%), haematoma (n = 8; 1.9%), infection (n = 9; 2.1%), and flap necrosis (n = 9; 2.1%). Thirty-four (10.8%) patients had an involved positive margin, 29 patients underwent re-excision (9.3%) and four underwent completion mastectomy (1.3%). One local recurrence and six distant recurrences were observed during a mean follow up of 21 months (1-49). A pooled patient cosmetic satisfaction descriptor of good or excellent was described in 93% of cases. CWPFs are a safe method of partial breast reconstruction following BCS. They are associated with a low complication rate, acceptable short-term oncological outcomes and satisfactory cosmetic outcome. There is a relative paucity in quality of data in this field and larger prospective studies are needed to investigate outcomes further.
Citation
Pujji OJS, Blackhall V, Romics L, Vidya R. Systematic review of partial breast reconstruction with pedicled perforator artery flaps: Clinical, oncological and cosmetic outcomes. Eur J Surg Oncol. 2021 Apr 13:S0748-7983(21)00395-4. doi: 10.1016/j.ejso.2021.03.249. Epub ahead of print. PMID: 33895022.