36 Chapter 3 ABSTRACT Introduction: Excision of the pectoral fascia (PF) is routinely performed in oncological mastectomies. Preservation of the PF may however decrease postoperative complication rates for bleeding, infections and seroma. It may also improve reconstructive outcomes by better prosthesis coverage, thereby reducing implant extrusion rates and improving cosmetic outcomes. Methods: A systematic review according to the PRISMA principles was performed. Studies describing PF preservation were searched in three databases. All studies including more than ten patients were included. The main outcomes were oncological safety (local recurrence, regional and distant metastases, mortality rates), complication rates (bleeding, infections, seroma), loss of the prosthesis after reconstructive surgery, and cosmetic outcomes following reconstruction. Results: Five studies were included. Three reported on two different randomized controlled trials (n=73, and n = 244), two studies were retrospective case series (n=203, and n=256). PF preservation did not affect oncological outcomes in terms of local recurrences, regional and distant metastases, nor mortality rates. One study described a significantly lower incidence of seroma in the PF preservation group. No differences were found for bleeding complications and infections. No objective data were provided for reconstructive complications nor cosmetic outcomes. Conclusions: The literature on PF preservation is scarce. Based on the current evidence, PF preservation seems oncologically safe while potentially reducing postoperative complication rates. It is expected that reconstructive outcomes will benefit from PF preservation, but these studies lack evidence on this topic. Future studies should provide insight into all aspects of PF preservation.
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