Immediate Versus Delayed Reconstruction Following Resection of Fungating Breast Tumors: A Systematic Review of Surgical Outcomes
Eric Perpetuo E. Arcilla, Clarissa Mae C. Gonzales, Ferri P. David- Paloyo, Gerardo G. Germar, Ramius Agustin Miguel D. Dizon, Siegfredo R. PaloyoBackground
Fungating breast tumors represent a severe form of locally advanced breast cancer, frequently affecting women in low- and middle-income countries (LMICs). The optimal timing of reconstruction (immediate vs. delayed) following tumor resection remains controversial, especially in resource-constrained settings.
Methods
A systematic review following PRISMA guidelines was conducted, searching PubMed, Cochrane Library, MEDLINE, and Google Scholar (January 2000-March 2024) for studies comparing immediate and delayed reconstruction in FBT patients. Eligible studies reported surgical complications, hospital stay, or adjuvant therapy timing. Risk of bias was assessed using the Newcastle-Ottawa Scale.
Results
Six retrospective cohort studies from India, Pakistan, South Korea, and the United States met inclusion criteria. Reconstruction techniques varied, including skin grafts, advancement flaps, and myocutaneous flaps. Immediate reconstruction was more frequently performed but was often associated with higher complication rates in infected or unstable patients. Delayed reconstruction was generally reserved for those with poor clinical status. All studies carried at least a moderate risk of bias.
Conclusion
Current evidence, though limited and heterogeneous, suggests that delayed reconstruction may offer a safer option for select FBT patients, particularly in LMICs. Prospective, standardized studies incorporating patient-reported outcomes are needed to inform clinical guidelines.