Adjunctive Treatments Reduce Ischemia-Reperfusion Injury in Breast Reconstruction After Mastectomy: A Systematic Review
- 1Department of Research, California Northstate University College of Medicine, Elk Grove, USA
Abstract
Ischemia-reperfusion injury (IRI) is a common postoperative outcome of free flap surgery in breast reconstruction post-mastectomy. Various approaches to limiting IRI have been investigated. The purpose of this review is to evaluate studies that compare ischemia-reducing therapies in breast reconstruction patients. PubMed and Embase databases were screened using a search algorithm. Patient demographics and study details, including ischemia-reducing intervention agents and postoperative outcomes, such as flap loss, thrombosis, systemic response, and vascular response, were extracted for evaluation. Ten studies were included in this review, with data on 1178 flaps in 935 female patients. Postoperative infusion of IV arginine resulted in greater blood flow to the distal flap (p = 0.04). Intervention with IV methylprednisolone yielded significantly reduced rates of partial flap necrosis (PFN) (p = 0.009), significantly decreased postoperative levels of IL-1β (p = 0.0004), IL-10 (p = 0.00044), and TNF (p = 0.00011), and shorter length of hospital stay (p = 0.00001). Many adjunctive therapies are associated with lower rates of IRI in breast reconstruction post-mastectomy. Of these therapies, postoperative IV arginine resulted in greater blood flow to the distal flap, while perioperative IV methylprednisolone resulted in a significant reduction in PFN and other markers of IRI. Future studies should focus on the effects of steroid and/or vasodilator administration on IRI and seek to establish lasting protective effects.
Related
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- Comparison of surgical outcomes, safety, and cosmetic satisfaction between immediate implant-based and transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction following total mastectomy: a retrospective cohort study
- Long-term implant integrity and complications after risk-reducing mastectomy with immediate implant reconstruction: a retrospective cohort study with prospective ultrasound follow-up at a Swedish university hospital
- Pre-Pectoral Breast Reconstruction after Mastectomy: Current Evidence, Knowledge Gaps, and Rationale for the I-PREPARE EUBREAST-11R Trial
- Advances in Implant-Based Breast Reconstruction in the Setting of Post-Mastectomy Radiotherapy
BibTeX
@article{georgies2026adjunctive,
title = {{Adjunctive Treatments Reduce Ischemia-Reperfusion Injury in Breast Reconstruction After Mastectomy: A Systematic Review}},
author = {Marina M Georgies and Iyawnna Hazzard and Manya Bali and Ethan A Tabaie and Jose Puglisi and Eldo Frezza},
journal = {Cureus},
year = {2026},
month = oct,
doi = {10.7759/cureus.117393},
url = {https://europepmc.org/article/PMC/PMC13726743},
note = {CC BY},
}
RIS
TY - JOUR
TI - Adjunctive Treatments Reduce Ischemia-Reperfusion Injury in Breast Reconstruction After Mastectomy: A Systematic Review
AU - Marina M Georgies
AU - Iyawnna Hazzard
AU - Manya Bali
AU - Ethan A Tabaie
AU - Jose Puglisi
AU - Eldo Frezza
PY - 2026
DA - 2026/10/03
JO - Cureus
DO - 10.7759/cureus.117393
UR - https://europepmc.org/article/PMC/PMC13726743
AB - Ischemia-reperfusion injury (IRI) is a common postoperative outcome of free flap surgery in breast reconstruction post-mastectomy. Various approaches to limiting IRI have been investigated. The purpose of this review is to evaluate studies that compare ischemia-reducing therapies in breast reconstruction patients. PubMed and Embase databases were screened using a search algorithm. Patient demographics and study details, including ischemia-reducing intervention agents and postoperative outcomes, such as flap loss, thrombosis, systemic response, and vascular response, were extracted for evaluation. Ten studies were included in this review, with data on 1178 flaps in 935 female patients. Postoperative infusion of IV arginine resulted in greater blood flow to the distal flap (p = 0.04). Intervention with IV methylprednisolone yielded significantly reduced rates of partial flap necrosis (PFN) (p = 0.009), significantly decreased postoperative levels of IL-1β (p = 0.0004), IL-10 (p = 0.00044), and TNF (p = 0.00011), and shorter length of hospital stay (p = 0.00001). Many adjunctive therapies are associated with lower rates of IRI in breast reconstruction post-mastectomy. Of these therapies, postoperative IV arginine resulted in greater blood flow to the distal flap, while perioperative IV methylprednisolone resulted in a significant reduction in PFN and other markers of IRI. Future studies should focus on the effects of steroid and/or vasodilator administration on IRI and seek to establish lasting protective effects.
SN - 2168-8184
ER -