Hyperbaric Oxygen Therapy for Ischemic Complications After Immediate Breast Reconstruction: A Systematic Review and Meta-Analysis

Hyperbaric oxygen therapy (HBOT) has been proposed as an adjunct to enhance perfusion and support salvage of compromised breast reconstructions, but its role in the early postoperative phase remains insufficiently defined. This systematic review and meta-analysis evaluated the effectiveness and safety of HBOT during the early postoperative phase of first-stage breast reconstruction.

A PRISMA-compliant search of PubMed, EMBASE, Cochrane CENTRAL, Web of Science, ScienceDirect, Scopus, Google Scholar, and ClinicalTrials.gov was conducted from inception to October 2025. Eligible studies included adults undergoing immediate or first-stage breast reconstruction who received HBOT for postoperative ischemia or necrosis and reported at least one clinical outcome. Methodological quality was assessed using MINORS for the comparative cohort study and the Murad et al. framework for case series, and overall certainty was evaluated using GRADE. Single-arm random-effects meta-analyses were performed for major clinical endpoints.

Five observational studies (four case series and one retrospective cohort) comprising 409 patients met inclusion criteria, of whom 75 received HBOT. Therapy was typically initiated within the first 10 postoperative days and consisted of 10–20 sessions at 2.0–2.5 ATA. Pooled single-arm estimates demonstrated flap salvage of 82% (95% CI 72–90%) and pocket salvage of 78% (95% CI 65–88%). Reoperation and explantation rates were 15% (95% CI 9–23%) and 8% (95% CI 4–15%), respectively. Postoperative infections occurred in 3% (95% CI 1–7%). Adverse events were mild and infrequent.

Although limited by small, predominantly observational studies and low certainty of evidence, current data suggest that HBOT may be a safe and potentially useful adjunct for managing ischemic complications after immediate breast reconstruction. Further well-designed prospective and randomized trials are required to define its optimal role.

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.