The effect of chemotherapy on the complication rates of implant and free flap breast reconstruction: A Systematic Review

Purpose This study investigated the impact of chemotherapy on complication rates of implant and free flap breast reconstruction. The effect of timing and dosage of chemotherapy in minimizing the breast reconstruction surgery (BRS) complications were also investigated. Methods PRISMA guidelines were used to search relevant studies published from January 2009 to September 2021. Quality of selected studies were assessed using GRADE assessment and risk of bias was performed using Cochrane Collaboration’s tool and ROBINS-I. Rates of major and minor complications of neoadjuvant systemic therapy (NST) and adjuvant systemic therapy (AST) were compared by t-test using GraphPad Prism v.9.3.0 and P value <0.05 was considered statistically significant. Results A total of 19 studies comprising 49,217 patients were included. The GRADE assessment showed low risk of bias and good quality across studies. Three-hundred and twenty patients had implant reconstruction, 3,172 had flap reconstruction and 46,062 had both flap and implant reconstruction surgery. There was no significant difference in complication rates of patients between flap reconstruction surgery and implants. (P=0.4) In all studies, total complication rates for post-chemotherapy BRS patients was 46.03% compared to 32.49% without chemotherapy (P=0.09). Overall major complications rate was 14.5% (P=0.61) with NST and 21.1% (P=0.69) with AST. Minor complications rate was 28.8% (P=0.97) with NST and 39.5% (P=0.59) with AST. Complication rate of NST was lower than AST, but not statistically significant (P=0.64). No significant correlation was found between timing/duration of chemotherapy and rates of BRS complications (P=0.76). Conclusion No significant difference in BRS complications with and without chemotherapy was established. Despite these results suggesting little difference between NST and AST or chemotherapy in BRS complications, prospective control studies are currently limited, and more are necessary to better inform surgeons and their patients.