Network Meta Analysis Of Complications And Satisfaction Of Different Breast Reconstruction Procedures

BackgroundWith the increasing incidence and rejuvenation of breast cancer,more and more women are facing breast loss or partial loss,which not only affects the appearance,but also destroys the psychology of patients,forcing surgeons to continue to explore breast reconstruction.In recent years,with the development of microsurgery and material science,breast reconstruction has developed by leaps and bounds.At present,there are many methods of breast reconstruction,which can be divided into autologous breast reconstruction and implantable breast reconstruction.Autologous tissue breast reconstruction includes latissimus dorsi myocutaneous flap（LD）,transverse rectus abdominis myocutaneous flap（TRAM）,inferior deep epigastric artery perforator flap（DIEP）,superficial inferior epigastric artery flap（SIEA）and so on.Implantable breast reconstruction includes simple prosthesis implantation（SSR）,dilator-prosthesis secondary breast reconstruction（TSR）,skin flap combined with prosthesis implantation（such as latissimus dorsi myocutaneous flap combined with prosthesis implantation（LDI）,etc.）.In addition,there are some new procedures,such as autologous fat transplantation and greater omentum breast reconstruction.At present,the systematic review and Meta analysis of breast reconstruction are mostly traditional Meta analysis,which is limited by the traditional Meta analysis and the number of original articles of some surgical procedures.Most Meta analysis focuses on the comparative study of autologous breast reconstruction or implantable breast reconstruction,but fails to make a systematic and comprehensive comparative analysis.Because there are many factors involved in breast reconstruction,such as the method of reconstruction,the time of reconstruction,whether radiotherapy is performed after operation and the timing of radiotherapy and reconstruction,it is difficult to describe it completely in this paper.therefore,six reconstruction methods,such as DIEP,TRAM,LD,LDI,SSR and TSR,are selected for Network Meta analysis to rank the complications and patient satisfaction of different reconstruction procedures.With a view to a more comprehensive understanding of the advantages and disadvantages of different reconstruction procedures,to provide some guidance for clinicians.ObjectiveThe complications and satisfaction of different breast reconstruction procedures were systematically evaluated by Network Meta analysis.MethodsEmbase,Pub Med,Cochrane Library and other databases were searched from the establishment of the database to October 2021.The literature was screened according to the inclusion criteria and exclusion criteria,the quality of the literature was evaluated with reference to the NOS scale,and the included literature was analyzed by Network Meta using the R language based on Bayesian school.Results:A total of 57 articles were included in a retrospective study of 22990 patients,including transverse rectus abdominis myocutaneous flap（TRAM）in 4365 cases,inferior deep epigastric artery perforator flap（DIEP）in 4218 cases,latissimus dorsi myocutaneous flap（LD）in 4218 cases,latissimus dorsi myocutaneous flap combined with prosthesis implantation（LDI）in 576 cases,simple prosthesis implantation（SSR）in 5716 cases,and dilator-prosthesis secondary breast reconstruction（TSR）in 7646 cases.The evaluation indexes included total postoperative complications,seroma,hematoma,infection,fat liquefaction,breast satisfaction and sexual life satisfaction.The results of Network Meta analysis showed that the cumulative probability of breast satisfaction and sexual life satisfaction was from high to low: the cumulative probability of total incidence of complications after TRAM,DIEP,SSR and TSR;was from high to low;the cumulative probability of infection of DIEP,TRAM,LD,LDI,SSR and TSR;was from high to low;the cumulative probability of TSR,SSR,LD,TRAM,LDI,DIEP;hematoma was from high to low: LD,LDI,DIEP,TRAM,SSR,TSR.The cumulative probability of the possibility of serum swelling was from high to low: LD,LDI,TSR,SSR,DIEP,TRAM.Conclusion:The satisfaction of autologous breast reconstruction is higher than that of implantbased breast reconstruction;the incidence of complications of autologous breast reconstruction is higher than that of implant-based breast reconstruction;abdominal flap is still the gold standard of breast reconstruction.