Structured Abstract

Contents

• Preface
• Acknowledgments
• Key Informants
• Technical Expert Panel
• Peer Reviewers
• Evidence Summary
  • Main Points
  • Background and Purpose
  • Methods
  • Results
  • Limitations
  • Implications and Conclusions
• Introduction
  • Background
  • Purpose of the Review
• Methods
  • Review Approach
  • Study Selection
  • Data Extraction and Data Management
  • Assessment of Risk of Bias in Individual Studies
  • Data Synthesis
  • Grading the Strength of Evidence for Major Comparisons and Outcomes
• Results
  • Literature Search Results
  • Description of Included Evidence
  • Key Question 1. Implant-Based Reconstruction Versus Autologous Reconstruction
  • Key Question 2. Timing of Implant-Based Reconstruction or Autologous Reconstruction in Relation to Chemotherapy and Radiation Therapy
  • Key Question 3. Comparisons of Implant Materials for Implant-Based Reconstruction
  • Key Question 4. Comparisons of Anatomic Planes of Implant Placement for Implant-Based Reconstruction
  • Key Question 5. Use of Human Acellular Dermal Matrices for Implant-Based Reconstruction
  • Key Question 6. Comparisons of Flap Types for Autologous Reconstruction
• Discussion
  • Findings in Relation to the Decisional Dilemmas
  • Strengths and Limitations
  • Applicability
  • Implications for Clinical Practice
  • Implications for Research
  • Conclusions
• References
• Appendixes
  • Appendix A. Methods
  • Appendix B. List of Excluded Studies
  • Appendix C. Results: Design, Arm, and Sample Details
  • Appendix D. Results: Risk of Bias
  • Appendix E. Results: Summary Tables for Outcomes
  • Appendix F. Results: Full Evidence Tables for Outcomes
  • Appendix G. Results: Evidence Profiles
  • Appendix H. Appendix References

Suggested citation:

Saldanha IJ, Cao W, Broyles JM, Adam GP, Bhuma MR, Mehta S, Dominici LS, Pusic AL, Balk EM. Breast Reconstruction After Mastectomy: A Systematic Review and Meta-Analysis. Comparative Effectiveness Review No. 245. (Prepared by the Brown Evidence-based Practice Center under Contract No. 75Q80120D00001.) AHRQ Publication No. 21-EHC027. Rockville, MD: Agency for Healthcare Research and Quality; July 2021. DOI: https://doi.org/10.23970/AHRQEPCCER245. Posted final reports are located on the Effective Health Care Program search page.

This report is based on research conducted by the Brown Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 75Q80120D00001). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.

The information in this report is intended to help healthcare decision makers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of healthcare services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.

This report is made available to the public under the terms of a licensing agreement between the author and the Agency for Healthcare Research and Quality. This report may be used and reprinted without permission except those copyrighted materials that are clearly noted in the report. Further reproduction of those copyrighted materials is prohibited without the express permission of copyright holders.

AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies, may not be stated or implied.

AHRQ appreciates appropriate acknowledgment and citation of its work. Suggested language for acknowledgment: This work was based on an evidence report, Breast Reconstruction After Mastectomy: A Systematic Review and Meta-Analysis, by the Evidence-based Practice Center Program at the Agency for Healthcare Research and Quality (AHRQ).