Behranwala K A, Dua R S, Ross G M, Ward A, A'hern R, Gui G P H
Department of Academic Surgery (Breast Unit), Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, United Kingdom.
J Plast Reconstr Aesthet Surg. 2006;59(10):1043-51. doi: 10.1016/j.bjps.2006.01.051. Epub 2006 Jun 12.
Capsular contracture occurs more frequently when immediate breast reconstruction (IBR) is associated with radiotherapy (RT) in a post-mastectomy field. The aim of this study was to investigate the impact of RT on surgical outcome after IBR using a single implant type.
One hundred and thirty-six breast reconstructions were studied in 114 patients: 62 reconstructions were performed using submuscular implants alone and 74 had an implant-assisted latissimus dorsi myocutaneous flap using a McGhan 150 biodimensional permanent expander implant. Data were prospectively collected on capsule contracture, geometric measurements, photographic assessments and pain scores. The median follow-up was 4 (range, 2-5) years.
The mean age of the 114 patients studied was 45 (range, 20-77) years. Forty-four reconstructed breasts received RT. Capsule formation was detected in 13/92 (14.1%) reconstructed breasts with no RT and in 17/44 (38.6%) reconstructed breasts with RT. On univariate analysis, RT was the only variable related to capsule formation (p<0.001). Significant differences in geometric measurements of symmetry were identified in patients with capsules compared with those without capsules. Photographic assessments were worse in the capsule group: mean photo score 8 (95% CI 8, 8.5) compared with the no capsule group 6.5 (95% CI 5, 7.5), p<0.001. Persistent pain two years or more after surgery was present in 8/30 patients with capsules and 1/106 with no capsule group, p<0.01. Capsule formation is three times more likely to occur after IBR in association with an RT field. However, as more than 60% of patients do not get capsules despite RT at four years, implant-assisted tissue expansion techniques using a biodimensional device is a viable breast reconstructive option in selected cases.
在乳房切除术后进行即刻乳房重建（IBR）并联合放疗（RT）时，包膜挛缩的发生率更高。本研究的目的是使用单一类型的植入物，探讨放疗对IBR术后手术效果的影响。
对114例患者的136例乳房重建进行了研究：其中62例仅使用胸大肌下植入物进行重建，74例使用McGhan 150生物维度永久性扩张器植入物进行植入物辅助的背阔肌肌皮瓣重建。前瞻性收集关于包膜挛缩、几何测量、照片评估和疼痛评分的数据。中位随访时间为4年（范围2 - 5年）。
所研究的114例患者的平均年龄为45岁（范围20 - 77岁）。44例重建乳房接受了放疗。在未接受放疗的92例重建乳房中有13例（14.1%）检测到包膜形成，在接受放疗的44例重建乳房中有17例（38.6%）检测到包膜形成。单因素分析显示，放疗是与包膜形成相关的唯一变量（p<0.001）。与无包膜的患者相比，有包膜的患者在对称性的几何测量上存在显著差异。照片评估在有包膜组更差：平均照片评分为8分（95%可信区间8, 8.5），而无包膜组为6.5分（95%可信区间5, 7.5），p<0.001。术后两年或更长时间持续疼痛在有包膜组的30例患者中有8例，无包膜组的106例患者中有1例，p<0.01。IBR联合放疗区域后包膜形成的可能性是其三倍。然而，由于超过60%的患者在四年时尽管接受了放疗但仍未形成包膜，在特定病例中使用生物维度装置的植入物辅助组织扩张技术是一种可行的乳房重建选择。
