PubMed, Embase, and Cochrane were searched for literature published up until December 2022. Studies that compared subpectoral and prepectoral breast reconstruction and reported at least one postoperative complication were included. The following 8 major outcomes were included: revision and reoperation, capsular contracture, explantation, seroma, hematoma, infection, skin necrosis, and animation deformity. Systematic review and meta-analysis were performed to compare outcomes of the 2 techniques. Subgroup analysis was performed to compare whether practice differences in different countries may have an impact on outcomes.
A total of 18 studies were identified in our literature search. Two thousand three hundred sixty patients were included, representing a total of 3135 breasts. Our analysis demonstrated that prepectoral reconstruction had significantly lower odds of developing postoperative hematoma [odds ratio (OR), 0.62; P = 0.05], seroma (OR, 0.67; P = 0.01), infection (OR, 0.64; P = 0.03), revision and reoperation (OR, 0.44; P < 0.00001), and animation deformity (OR, 0.01; P < 0.00001), compared with the subpectoral method. Subgroup analysis showed that differences between 3 countries (United States, Korea, Italy) are low (all subgroup heterogeneity test P > 0.1).
While both subpectoral and prepectoral are safe methods for breast reconstruction, the prepectoral technique may lead to lower odds of developing multiple major postoperative complications.
方法:PubMed,Embase,和Cochrane被搜索到2022年12月之前发表的文献。包括比较胸膜下和胸前乳房重建并报告至少一种术后并发症的研究。包括以下8个主要结果:修订和重新手术,包膜挛缩,外植体,血清肿,血肿,感染,皮肤坏死,和动画畸形。进行系统评价和荟萃分析以比较两种技术的结果。进行亚组分析以比较不同国家的实践差异是否可能对结果产生影响。
结果:在我们的文献检索中确定了总共18项研究。包括两千三百六十名患者,代表总共3135个乳房。我们的分析表明,胸前重建有显著较低的发生术后血肿的几率[优势比(OR),0.62;P=0.05],血清肿(或,0.67;P=0.01),感染(或,0.64;P=0.03),修订和重新操作(或,0.44;P<0.00001),和动画畸形(OR,0.01;P<0.00001),与胸下法相比。亚组分析表明,3个国家(美国,韩国,意大利)较低(所有亚组异质性检验P>0.1)。
结论:虽然胸下和胸前都是乳房重建的安全方法,胸前技术可能导致较低的发生多种主要术后并发症的几率.