Although many studies have concluded that breast reconstruction is beneficial to women undergoing mastectomy, they often measure outcomes that are of interest to surgeons rather than patients or do not compare reconstruction to no reconstruction. A systematic review of the literature was conducted on the question: Does breast reconstruction after mastectomy result in better outcomes than mastectomy alone?

Methods: The search strategy consisted of database queries (Pubmed, Cochrane), hand searching of journals, searching of references, consultation with experts in field. Inclusion criteria were as follows: population: women undergoing mastectomy for breast cancer; interventions: all types of breast reconstruction after mastectomy; outcomes: patient-centered, clinical and psychosocial outcomes; study designs: must compare outcomes of reconstruction to outcomes of no reconstruction; date: after 1980; language: English. Quality assessment criteria were based on the representativeness of the sample, representativeness of interventions, use of validated outcome measures, length of follow-up, study design, and method of analysis.

Results: 875 studies were identified by the search strategy, and 9 studies fit the inclusion criteria. The most common reason for exclusion was failure to measure a patient-oriented outcome, such as quality of life, satisfaction, patient assessment of appearance. Most studies measured outcomes of primary interest to the surgeon, such as surgeon assessment of appearance and complication rate. The next most common reason for exclusion was failure to compare outcomes of reconstruction to outcomes without reconstruction. Most studies only examined outcomes in patients who had chosen reconstruction. Only one study controlled for baseline psychosocial differences. Of the included studies, the most common outcome measured was health-related quality of life. Most studies used validated instruments. Three studies found that outcomes after reconstruction were better than outcomes of mastectomy without reconstruction. Two studies found poorer outcomes with reconstruction compared to mastectomy alone. Three studies found equivalent outcomes. One study was inconclusive. Earlier studies and studies with longer follow-up were more likely to find better outcomes with reconstruction. Excluded studies were more likely than included studies to conclude that breast reconstruction is beneficial. Remaining steps include review and rating by addition reviewers with measurement of inter-rater reliability and rating and analysis of studies for quality. No relationship between study quality and findings about benefits was found.

Conclusions: The benefits of breast reconstruction have not been convincingly demonstrated. Quality of life outcomes after reconstruction may be equivalent to or worse than no reconstruction for some women. Few studies utilize patient-oriented outcomes and compare reconstruction to no reconstruction. Future studies should identify which women are most likely to benefit from reconstruction.