title: Radiotherapy and nipple-areolar complex necrosis after nipple-sparing mastectomy: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To perform a meta-analysis to determine the effect of radiotherapy (RT) on nipple-areolar complex (NAC) and skin flap necrosis, and local recurrence in women who undergo nipple-sparing mastectomy (NSM) and immediate breast reconstruction.
  
  
  METHODS
  Medline, PubMed, Cochrane, and Google Scholar databases were searched until October 16, 2015. Randomized-controlled-trials, prospective, retrospective, and cohort studies were included. The primary outcome was the NAC necrosis rate, and the secondary outcomes were the skin flap necrosis and local recurrence rates.
  
  
  RESULTS
  Of 186 studies identified, 2 prospective and 5 retrospective studies including a total of 3692 patients were included in the meta-analysis. Five, 3, and 2 studies reported data of NAC necrosis (3461 breasts), skin flap necrosis (2490 breasts), and local recurrence (988 breasts), respectively. Pooled results showed no difference in the odds of NAC necrosis [odds ratio (OR) = 1.250, 95% confidence interval (CI) 0.481-3.247, P = 0.647], or local recurrence (OR = 0.564, 95% CI 0.056-5.710, P = 0.627) between patients who received and did not receive RT. Patients treated with RT had a higher likelihood of skin flap necrosis (OR = 2.534, 95% CI 1.720-3.735, P < 0.001). Significant heterogeneity, however, was noted in the analysis of NAC and local recurrence.
  
  
  CONCLUSIONS
  Because of the limitations of the small number of studies and heterogeneity in the analysis, this study does not allow drawing any definitive conclusions and highlights the need of well-controlled trials to determine the effect of RT in patients undergoing NSM.
authors.affiliation: Department of Thyroid and Breast Surgery, Zhejiang Provincial People's Hospital, No. 158 Shangtang Road, Hangzhou, 310014, China.
authors.forename: Yajuan
authors.initials: Y
authors.lastname: Zheng
authors.affiliation: Department of Thyroid and Breast Surgery, Zhejiang Provincial People's Hospital, No. 158 Shangtang Road, Hangzhou, 310014, China. zhongmiaochun@126.com.
authors.forename: Miaochun
authors.initials: M
authors.lastname: Zhong
authors.affiliation: Department of Thyroid and Breast Surgery, Zhejiang Provincial People's Hospital, No. 158 Shangtang Road, Hangzhou, 310014, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Ni
authors.affiliation: Department of Thyroid and Breast Surgery, Zhejiang Provincial People's Hospital, No. 158 Shangtang Road, Hangzhou, 310014, China.
authors.forename: Hongjun
authors.initials: H
authors.lastname: Yuan
authors.affiliation: Department of Thyroid and Breast Surgery, Zhejiang Provincial People's Hospital, No. 158 Shangtang Road, Hangzhou, 310014, China.
authors.forename: Jingxia
authors.initials: J
authors.lastname: Zhang
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology; D009364:Neoplasm Recurrence, Local; D009558:Nipples / Q000473:pathology* / Q000528:radiation effects; D016017:Odds Ratio; D059351:Organ Sparing Treatments; D017063:Outcome Assessment, Health Care; D011832:Radiation Injuries / Q000473:pathology*; D011878:Radiotherapy / Q000009:adverse effects; D012680:Sensitivity and Specificity; D013524:Surgical Flaps / Q000473:pathology*
keywords: Breast cancer; Necrosis; Nipple-sparing mastectomy; Nipple–areolar complex; Recurrence