Meta-analysis and systematic review of long-term oncological safety of immediate breast reconstruction in patients with locally advanced breast cancer

Background: Immediate breast reconstruction (IBR) in locally advanced breast cancer (LABC) (stage 3A and above) is widely debated, both in terms of delay of adjuvant therapy and oncological safety. This study aims to systematically review and evaluate the longterm oncological safety of IBR in patients with LABC undergoing mastectomy. Methods: Search conducted using Medline, Embase, PubMed and Google Scholar between 1 and 24 December 2023 involving patients with LABC who underwent mastectomy with or without IBR were included. The meta-analysis included studies comparing IBR with mastectomy alone in patients with LABC with the primary outcomes of 5-year overall survival, disease-free survival and local and distant recurrence rates. Results: A total of 19,907 patients were included spanning 10 papers. Of these, 89.1% underwent mastectomy alone, while 10.9% underwent IBR (51.2% autologous and 48.8% implant- based reconstruction). The 5-year overall survival rate was higher in IBR compared to mastectomy alone (IBR n = 2038/2491 81.8%, vs. Mx only n = 7468/10,124 73.7%, RR 1.10 [95% CI 1.07-1.12], P < 0.001). No significant difference found in 5-year disease-free survival (IBR n = 510/689 74.0% vs. Mx only n = 1339/1924 69.6%, RR 1.06 [95% CI 0.98-1.15], P = 0.17), 5year local recurrence groups (IBR n = 52/646 8.0% vs. Mx only n = 122/1708 7.1%, RR 0.80 [95% CI 0.46-1.38], P = 0.42), or 5-year distant recurrence rates (IBR n = 117/594 19.6% vs. Mx only n = 211/882 23.9%, P = 0.11). Conclusion: IBR in LABC may be associated with improved overall 5-year survival rates without affecting disease-free survival or recurrence rates. Therefore, IBR may be a safe option in the treatment of LABC when considering optimal oncological outcomes. (c) 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.