ReviewJPRAS open2026
Indications, safety and aesthetic outcomes of autologous conversion after implant-based breast reconstruction failure: A systematic review and meta-analysis.
Review in JPRAS open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
0 citing papers in PubMed.
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Implant-based breast reconstruction (IBBR) is widely used after mastectomy but is limited by implant-related morbidity and failure, particularly in irradiated patients. Autologous conversion (implant removal followed by flap reconstruction) is increasingly performed, yet indications, safety, and aesthetic outcomes remain inconsistently reported. Methods: A systematic review was conducted according to PRISMA 2020. PubMed, Scopus, and Cochrane CENTRAL were searched from inception to January 2026. Studies reporting implant removal followed by autologous reconstruction after mastectomy were included. Primary outcomes were (1) indications for conversion and (2) surgical safety, including major postoperative complications and total flap loss. Safety outcomes were pooled using random-effects meta-analysis of proportions; comparative meta-analysis versus primary autologous breast reconstruction, including immediate, delayed, or delayed-immediate reconstruction (P-ABR), was conducted when eligible data were available. Aesthetic outcomes were synthesized descriptively. Results: Nineteen studies (1994-2025) including 1304 patients and 1552 reconstructed breasts were included. Conversion was predominantly performed using free flaps (91.5%), most commonly abdominal-based reconstructions (72.8%). Most conversions were elective, primarily for capsular contracture and dissatisfaction; obligatory implant removal leading to conversions were mainly driven by infection and soft-tissue compromise. The pooled major complication rate was 10.8% (95% CI, [8.12-14.19]; I² = 52.9%) and pooled total flap loss was 2.00% (95% CI, [1.43-2.83]; I² = 0%). Comparative analysis showed no statistically significant difference in major complications between conversion and P-ABR (RR, 1.68; 95% CI, [0.70-4.01]; I² = 0%). Pre-post analyses or comparison with continued IBBR showed improved aesthetic outcomes after conversion. Conclusions: Autologous conversion after IBBR is most often performed electively for chronic implant-related morbidity or dissatisfaction and demonstrates low flap loss with acceptable complication rates.
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