Abstract：
BACKGROUND: Autologous flaps may have superior outcomes when compared to implant breast reconstruction in patients with obesity. To date, no published review has illustrated the superiority of autologous to implant-based reconstruction in this study group in terms of aesthetics outcomes and surgical complications.
METHODS: A systematic search was conducted on PubMed, Cochrane, Google Scholar, and Embase from inception to December 31, 2020. Studies comparing the outcomes (patient satisfaction and complications) of autologous versus implant-based reconstruction in patients with BMI > 30 were selected.
RESULTS: The search yielded 1633 articles, of which 76 were assessed in full text. A total of 12 articles fit inclusion for qualitative review; of them, 7 were meta-analyzed. Autologous reconstruction had a lower incidence of infection (OR 0.74 [95% CI 0.59, 0.92]), hematoma/seroma formation (OR 0.34 [95% CI 0.23, 0.49]), and reconstructive failure (OR 0.47 [95% CI 0.36, 0.62]), but not skin necrosis (OR 0.95 [95% CI 0.73, 1.25]) or wound dehiscence (OR 1.03 [95% CI 0.72, 1.49]) when compared to implant-based reconstruction. Deep vein thrombosis (DVT) and pulmonary embolism occurred more frequently with autologous versus alloplastic reconstruction (OR 2.21 [95% CI 1.09, 4.49] for DVT and OR 2.49 [95% CI 1.13, 5.48] for PE). BREASTQ scores were higher for the autologous breast reconstruction when compared to implant-based group, but failed to reach significance (p value >0.05).
CONCLUSIONS: The current evidence in the literature suggests that autologous breast reconstruction has lower surgical complication rate when compared to implant-based reconstruction at the expense of higher risk of thrombotic complications for patients with BMI > 30.
UNASSIGNED: 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 .
METHODS: A systematic search was conducted on PubMed, Cochrane, Google Scholar, and Embase from inception to December 31, 2020. Studies comparing the outcomes (patient satisfaction and complications) of autologous versus implant-based reconstruction in patients with BMI > 30 were selected.
RESULTS: The search yielded 1633 articles, of which 76 were assessed in full text. A total of 12 articles fit inclusion for qualitative review; of them, 7 were meta-analyzed. Autologous reconstruction had a lower incidence of infection (OR 0.74 [95% CI 0.59, 0.92]), hematoma/seroma formation (OR 0.34 [95% CI 0.23, 0.49]), and reconstructive failure (OR 0.47 [95% CI 0.36, 0.62]), but not skin necrosis (OR 0.95 [95% CI 0.73, 1.25]) or wound dehiscence (OR 1.03 [95% CI 0.72, 1.49]) when compared to implant-based reconstruction. Deep vein thrombosis (DVT) and pulmonary embolism occurred more frequently with autologous versus alloplastic reconstruction (OR 2.21 [95% CI 1.09, 4.49] for DVT and OR 2.49 [95% CI 1.13, 5.48] for PE). BREASTQ scores were higher for the autologous breast reconstruction when compared to implant-based group, but failed to reach significance (p value >0.05).
CONCLUSIONS: The current evidence in the literature suggests that autologous breast reconstruction has lower surgical complication rate when compared to implant-based reconstruction at the expense of higher risk of thrombotic complications for patients with BMI > 30.
UNASSIGNED: 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 .
摘要：
背景：在肥胖患者中，与种植体乳房重建相比，自体皮瓣可能具有更好的效果。迄今为止,在美学结局和手术并发症方面,本研究组中没有发表的综述说明自体重建与植入物重建的优越性.
方法：在PubMed上进行了系统搜索，科克伦,谷歌学者，和Embase从成立到2020年12月31日。选择比较BMI>30的患者自体重建和基于植入物重建的结果（患者满意度和并发症）的研究。
结果：搜索产生了1633篇文章，其中76项进行了全文评估。共有12篇文章适合纳入定性审查；其中，7进行了荟萃分析。自体重建具有较低的感染发生率(OR0.74[95%CI0.59,0.92]),血肿/血清瘤形成（OR0.34[95％CI0.23，0.49]），和重建失败(OR0.47[95%CI0.36，0.62])，但与基于植入物的重建相比，皮肤坏死(OR0.95[95%CI0.73,1.25])或伤口裂开(OR1.03[95%CI0.72,1.49])。自体重建与异体重建相比，深静脉血栓形成（DVT）和肺栓塞的发生率更高（DVT的OR为2.21[95％CI1.09，4.49]，PE的OR为2.49[95％CI1.13，5.48]）。与基于植入物的组相比，自体乳房重建的BREASTQ评分更高，但未能达到显著性(p值>0.05)。
结论：目前文献中的证据表明，对于BMI>30的患者，自体乳房重建与基于植入物的重建相比具有更低的手术并发症发生率。
■本期刊要求作者为每篇文章分配一定程度的证据。对于这些循证医学评级的完整描述，请参阅目录或在线作者说明www。springer.com/00266.
方法：在PubMed上进行了系统搜索，科克伦,谷歌学者，和Embase从成立到2020年12月31日。选择比较BMI>30的患者自体重建和基于植入物重建的结果（患者满意度和并发症）的研究。
结果：搜索产生了1633篇文章，其中76项进行了全文评估。共有12篇文章适合纳入定性审查；其中，7进行了荟萃分析。自体重建具有较低的感染发生率(OR0.74[95%CI0.59,0.92]),血肿/血清瘤形成（OR0.34[95％CI0.23，0.49]），和重建失败(OR0.47[95%CI0.36，0.62])，但与基于植入物的重建相比，皮肤坏死(OR0.95[95%CI0.73,1.25])或伤口裂开(OR1.03[95%CI0.72,1.49])。自体重建与异体重建相比，深静脉血栓形成（DVT）和肺栓塞的发生率更高（DVT的OR为2.21[95％CI1.09，4.49]，PE的OR为2.49[95％CI1.13，5.48]）。与基于植入物的组相比，自体乳房重建的BREASTQ评分更高，但未能达到显著性(p值>0.05)。
结论：目前文献中的证据表明，对于BMI>30的患者，自体乳房重建与基于植入物的重建相比具有更低的手术并发症发生率。
■本期刊要求作者为每篇文章分配一定程度的证据。对于这些循证医学评级的完整描述，请参阅目录或在线作者说明www。springer.com/00266.
