John:  Alongside several Cochrane Reviews of anti-cancer therapy for women with breast cancer, are those examining the effects of interventions that might help them after the completion of those treatments. In this podcast, Hayley Hassan, on behalf of the authors, tells us about one of these reviews, which compares different options for breast reconstruction and was published in May 2016.

Hayley : Women affected by breast cancer can choose from many options for breast reconstruction following their mastectomy. Their aim is to achieve a reconstructed breast that presents a natural feel combined with a size and shape that meets their individual needs. These reconstructive options are also available for women at high risk of developing breast cancer who choose to undergo risk-reducing mastectomy.
Breast reconstruction can either be done at the same time as the surgery to remove the breast cancer, which is is called immediate reconstruction, or delayed until adjuvant treatments such as chemotherapy have been completed. Both immediate and delayed reconstruction can be performed using tissue from the woman’s own body or using implants. We focused on the latter, seeking information on a variety of different types of implant, including textured, smooth, and silicone- or saline-filled.
Implant-based breast reconstruction allows restoration of a woman’s lost physical image with good cosmetic results. But the implants can cause some short- and long-term complications, including a problem caused by scar tissue around the implant called capsular contracture, infection, rupture of the implant and the collection of clotted blood or fluid, called haematoma and seroma respectively. Different types of implant present different rates of complications and there is no consensus about the best type to use.
Therefore, we did this Cochrane Review to assess the effects of different types of breast implants on complications, post-operative satisfaction and quality of life in women who have undergone reconstructive breast surgery after mastectomy. Our aim was to offer women undergoing this type of surgery a complete picture about the possible benefits and harms of these procedures.
nfortunately, though, very few women have been involved in the randomised trials that would provide more definitive investigation of the effects of implant breast reconstruction than other types of study. This is despite breast cancer surgery being one of the most commonly performed procedures in surgical oncology but a lack of randomisation is common in surgical research, reflecting the challenges of conducting surgical trials. Another finding from this review is that the outcomes reported in each study were often assessed using scales that were not standardised, making it difficult to compare or combine the results. The included trials also had methodological shortcomings that placed them at high risk of bias, meaning that we are less confident in their reported results.
Taking all this together, the available evidence is too weak to draw conclusions about which is the best implant for breast reconstructive surgery and it appears that current trends in breast reconstructive surgery are driven by studies that use designs that are generally inferior to randomised trials. We believe that this issue should be discussed when informing women about the possible benefits, harms and complications of surgery for breast reconstruction. It would also be helfpul to have better clinical reporting of outcomes in this area of research and a review of evidence from non-randomised studies.

John: If you would like to read about the five randomised trials that Nicola and his colleagues were able to include in their review, you can find it with a simple search for 'reconstructive breast surgery' at Cochrane Library dot com'.