Ten studies (n=980) were included: one prospective study (n=111), and seven retrospective chart reviews with control groups (n=780) and two without control groups (n=89).
The studies were of variable quality and only one used a prospective design. None of the studies reported a power calculation or reported confidence intervals when detailing the significance of the results. Five studies described an objective method of assessing the cosmetic outcome and four of these reported blinded independent outcome assessment.
Four studies compared radiotherapy before (three studies) or after (one study) breast reconstruction with no radiotherapy. Three studies reported increased complication rates with radiotherapy, while one study reported similar complication rates in both groups. The limited sample size meant that these results should be interpreted with caution.
Three studies compared the outcomes of patients with radiotherapy before reconstruction with radiotherapy after reconstruction. One study found that TRAM breast reconstruction before or after radiotherapy was associated with satisfactory cosmetic outcome and similar rates of complication. Two studies reported that patients had higher rates of complications immediately post TRAM.
One study did not present separate data for each treatment group but reported that reconstruction after radiotherapy may improve the outcome. Two studies did not have a control group or comparison group.