{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T11:29:51Z","timestamp":1788866991471,"version":"build-2803163510"},"reference-count":44,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:00:00Z","timestamp":1769731200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:00:00Z","timestamp":1769731200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100002794","name":"Cancerfonden","doi-asserted-by":"publisher","award":["21 0279 SCIA"],"award-info":[{"award-number":["21 0279 SCIA"]}],"id":[{"id":"10.13039\/501100002794","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>As bariatric surgery becomes increasingly common, reconstructive surgeons are encountering more massive weight loss (MWL) patients requiring breast reconstruction. MWL alters breast anatomy, tissue characteristics, and healing capacity, potentially impacting reconstructive outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To update and evaluate the evidence on how MWL affects complication and revision rates, flap\u2010relevant anatomy, and patient\u2010reported outcomes (PROMs) following postmastectomy breast reconstruction. In addition, research gaps were identified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This systematic review updated a previous review and followed PRISMA guidelines. Eligible studies included cohort studies and case series of postmastectomy breast reconstruction after MWL. Data extraction and appraisal were performed independently by two reviewers, with evidence quality rated using the GRADE system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Fifteen studies met the inclusion criteria, including three case\u2013control studies and twelve case series, reporting outcomes for 102 patients after massive weight loss (MWL). Most reconstructions used abdominally based free flaps, with few MWL\u2010specific modifications. MWL patients experienced significantly higher rates of delayed wound healing, surgical\u2010site infection, fat necrosis, and need for revision compared with controls, while total flap loss rates were similar. Evidence on implant\u2010based reconstruction, vascular anatomy, and PROMs was scarce. The overall certainty of evidence was very low (GRADE \u2295\u229d\u229d\u229d).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Breast reconstruction after MWL is associated with increased wound\u2010healing complications and revision rates, though patient satisfaction appears acceptable. Evidence remains limited by small, heterogeneous studies and a lack of controlled or prospective data. Future research should address optimal reconstructive techniques, timing, and patient selection, including the identification of modifiable risk factors and the use of PROMs to guide evidence\u2010based care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/micr.70185","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T11:50:32Z","timestamp":1769773832000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Postmastectomy Breast Reconstruction Following Massive Weight Loss: An Updated Systematic Review and Identification of Research Gaps"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7043-0063","authenticated-orcid":false,"given":"Anna","family":"Paganini","sequence":"first","affiliation":[{"name":"Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy University of Gothenburg  Gothenburg Sweden"},{"name":"Department of Plastic Surgery Sahlgrenska University Hospital, Region V\u00e4stra G\u00f6taland  Gothenburg Sweden"},{"name":"Department of Diagnostics, Acute and Critical Care, Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg University of Gothenburg  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"L\u00f6fstrand","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy University of Gothenburg  Gothenburg Sweden"},{"name":"Department of Plastic Surgery Sahlgrenska University Hospital, Region V\u00e4stra G\u00f6taland  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1434-8448","authenticated-orcid":false,"given":"Nushin","family":"Mirzaei","sequence":"additional","affiliation":[{"name":"Department of Surgery, Sahlgrenska Centre for Cancer Research, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3218-0881","authenticated-orcid":false,"given":"Emma","family":"Hansson","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy University of Gothenburg  Gothenburg Sweden"},{"name":"Department of Plastic Surgery Sahlgrenska University Hospital, Region V\u00e4stra G\u00f6taland  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,30]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000001204"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e31817d6023"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e31818d20d6"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3181b98bb4"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000002260"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30184"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cps.2018.08.013"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/gox.0000000000006223"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.21037\/gs\u201023\u2010397"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00266\u2010017\u20100992\u2010y"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/prs.0000000000003294"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000000677"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2023.0530"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anplas.2023.02.007"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anplas.2020.01.005"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e31818cbf80"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3181b457ea"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39489.470347.AD"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cps.2022.10.008"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000011797"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/asj\/sjaf234"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11695\u2010024\u201007066\u2010y"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20102004\u2010831905"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1590\/0100\u201069912016003005"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/obr.13419"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jviscsurg.2022.12.004"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00266\u2010021\u201002315\u20102"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000000526"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2024.04.061"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anplas.2022.07.023"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00266\u2010019\u201001540\u20100"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2013.01.003"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2018.01.012"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000002940"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000010318"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2021-247182"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2023.1160809"},{"issue":"11","key":"e_1_2_9_40_1","first-page":"1","article-title":"Surgical Techniques for Correction of the Breast in Women After Massive Weight Loss","volume":"184","author":"Thomsen J. B.","year":"2022","journal-title":"Ugeskrift for Laeger"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11695\u2010015\u20101613\u2010y"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1381\/096089200321593968"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2017.11.015"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.7507\/1002\u20101892.201910043"},{"key":"e_1_2_9_45_1","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000004186"}],"container-title":["Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/micr.70185","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/micr.70185","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/micr.70185","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T17:26:48Z","timestamp":1786987608000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/micr.70185"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,30]]},"references-count":44,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1002\/micr.70185"],"URL":"https:\/\/doi.org\/10.1002\/micr.70185","archive":["Portico"],"relation":{},"ISSN":["0738-1085","1098-2752"],"issn-type":[{"value":"0738-1085","type":"print"},{"value":"1098-2752","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,30]]},"assertion":[{"value":"2025-10-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-17","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-30","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70185"}}