1042 The Effect of Breast Reconstruction Type on Complication Rates and Patient Satisfaction in The Setting of Postmastectomy Radiotherapy (PMRT)

Abstract

Abstract Introduction The National Institute for Health and Care Excellence recommend offering post mastectomy radiotherapy (PMRT) to people with involved resection margins. With increasing evidence supporting the effectiveness of PMRT, it is important to optimise the outcomes of breast reconstruction in women receiving PMRT. Method A search was conducted in the PubMed database. The exclusion criteria were patients undergoing neoadjuvant radiotherapy and patients with metastases. The primary outcomes were patient satisfaction and complication rates. Results A meta-analysis (N = 380) found prosthetic reconstructions were 5 times more likely to develop complications than autologous reconstructions in the setting of PMRT (OR = 0.20, 95% CI = 0.1-0.4). A systematic review (N = 5437) had higher rates of total complications in prosthetic reconstructions compared to autologous reconstructions (41.3% vs 30.9%) with PMRT. Similarly, a retrospective study of PMRT patients (N = 622) had higher rates of complications with prosthetic reconstructions compared to autologous reconstructions (OR = 0.47, 95% CI = 0.27-0.82, P = 0.007). The adjusted mean satisfaction score (AMSS) of patients with autologous and prosthetic reconstructions receiving PMRT in a study (N = 54) was 4.4 and 2.8, respectively. Patient-reported satisfaction in a study (N = 622) was higher in patients with autologous (AMSS=63.5, 95% CI = 55.9-71.1) compared to prosthetic reconstructions (AMSS=47.7, 95% CI = 40.2-55.2) (all P = 0.002) with PMRT. Conclusions Existing data suggests that autologous tissue reconstructions tend to be more compatible with PMRT than prosthetic reconstructions in terms of patient satisfaction and complication rates. Although more research is needed to support these findings, current data can help patients and physicians make informed decisions regarding the type of breast reconstruction to use with PMRT.