Impact of premastectomy versus postmastectomy radiotherapy on postoperative complications in breast reconstruction: A systematic review and meta-analysis

Background: The present study aimed to performed a systemic review and meta-analysis to compare. Impact of premastectomy radiotherapy (Pre-MRT) versus Postmastectomy radiotherapy (PMRT) on Postoperative Complications in Breast Reconstruction. Methods: PubMed, Web of Science, and the Cochrane Library were searched from inception to February 3, 2026. Eligible studies compared Pre-MRT and PMRT for postoperative complications following breast reconstruction. Random-effects models were used to estimate pooled risk ratios (RRs) with 95% confidence intervals (CIs). Results: Three studies, including one randomized-controlled trial and two cohort studies comprising a total of 483 breasts were included in the meta-analysis. The meta-analysis demonstrated no significant difference in the rate of postoperative complications between the PreMRT and PMRT groups (pooled RR: 1.36; 95% confidence interval [CI]: 0.90-2.06; p = 0.0583). Subgroup analyses demonstrated no statistically significant differences observed in the rates of complete flap loss, skin flap necrosis, local recurrence, hematoma, seroma, infection, implant loss, or complete nipple necrosis. Conclusion: This meta-analysis did not demonstrate a statistically significant difference in postoperative complication rates between PreMRT and PMRT in patients undergoing breast reconstruction. However, given the limited number of included studies and the imprecision of the pooled estimates, these findings should be interpreted with caution.