Looking beyond the prepectoral breast reconstruction experience: a systematic literature review on associated oncological safety and cancer recurrence incidence

Background Prepectoral implant-based breast reconstruction has gained popularity in the last years, thanks to the development of accurate and tissue-sparing mastectomies together with the introduction of implant-covering devices as synthetic meshes and acellular dermal matrixes. Along with its diffusion, legitimate doubts on prepectoral reconstruction’s feasibility and oncological safety started raising. To date, there are no available data concerning oncologic outcomes following mastectomy and prepectoral breast reconstruction. Methods Electronic search in PubMed, Cochrane Library, and Web of Sciences databases was performed with no language restrictions. First articles’ identification was obtained through title and abstract descriptions and by full text visualization subsequently. Inclusion criterion was the report of outcomes assessment for oncological safety; thus cancer recurrence and incidence of systemic metastasis were recorded. Retrieved citations were screened by two reviewers, and inconsistencies were resolved by a third reviewer. Results Nine articles met the inclusion criteria and were included in the current review. Four studies presented control groups with submuscular reconstructions, and no statistical differences in terms of local or systemic recurrences were evidenced. Conclusions Taking into account the scarce number of articles at disposal, oncological safety of prepectoral breast reconstruction appears equal to the submuscular procedure. Further studies are needed to validate these data. Level of evidence: Not gradable.