Chest Wall Perforator Flaps in Breast Cancer Surgery: A Systematic Review of Clinical Outcomes, Complications, and Patient-Reported Satisfaction.

Abstract

Chest wall perforator flaps (CWPFs) offer a promising, volume-preserving reconstructive option for patients undergoing breast-conserving surgery. However, standardized data on safety, efficacy, and patient-reported outcomes remain limited. This systematic review was conducted in accordance with PRISMA guidelines. A comprehensive search of PubMed, Embase, clinical trial registries, and grey literature was performed up to April 2025. Primary outcomes were surgical complications, operative time, and validated patient satisfaction scores. Secondary outcomes included aesthetic assessments and oncologic safety. Methodological quality was assessed using the MINORS criteria. Meta-analysis was not performed due to heterogeneity. Fifty-two studies involving 2591 patients were included. Overall complication rates were low: seroma (5.0%), infection (∼2%), fat necrosis (1.6%), flap loss (0.7%), and wound dehiscence (1.5%). Cosmetic outcomes, when evaluated by patients or surgeons, were generally rated good to excellent. Validated PROMs were underutilized. Oncologic outcomes reported by a minority of studies suggested low locoregional (∼2%) and distant (∼4.3%) recurrence rates, with 5-year overall survival exceeding 90% in most series. CWPFs appear to provide favorable aesthetic outcomes with low short-term morbidity across heterogeneous observational cohorts. However, oncologic outcomes are sparsely reported with short and inconsistent follow-up and incomplete adjustment for tumor biology, systemic therapy, and radiotherapy. Accordingly, oncologic safety cannot be inferred from the current evidence, and the certainty of evidence for oncologic endpoints is very low. Prospective, standardized studies reporting LRR/DFS/OS at prespecified time-points and using validated PROMs are essential.