Women's Health Institute, Breast Surgery, Cleveland Clinic, Cleveland, OH, USA.
Ann Surg Oncol. 2010 Oct;17 Suppl 3:202-10. doi: 10.1245/s10434-010-1261-3. Epub 2010 Sep 19.
To evaluate risk factors for complications of tissue expander/implant and autologous tissue breast reconstructions and determine if radiation increases complication rates.
We performed a retrospective review of patients who underwent mastectomy plus autologous tissue or expander/implant reconstruction at the Cleveland Clinic. Univariate and multivariate analysis were performed in each group to evaluate for risk factors for complications. A complication was considered major if it required reoperation. A predictive model was used to compare the 2 groups to one another.
A total of 1037 patients were included in the study. In the tissue expander/implant population, there was a total complication rate of 31.8% and overall major complication rate of 24.4%. Radiation increased the major complication rate from 21.2 to 45.4%. However, 70.1% of the radiated patients ultimately had a successful implant-based reconstruction while an additional 10.3% went on to have autologous reconstruction. Age and body mass index (BMI) > 30 also led to higher major complication rates in tissue expander/implant reconstruction while smoking, hypertension, and chemotherapy had no impact. In the autologous reconstruction group, there was a total complication rate of 31.5% and a major complication rate of 19.7%. There was no statistically significant difference between the radiated and nonradiated autologous tissue reconstructions with major complication rates of 17.9 and 20.5%, respectively. BMI > 30 was the only significant factor leading to higher major complications in the autologous reconstructions.
Total complication rates were similar between tissue expander and autologous reconstructions. Increased major complication rates in patients with tissue expander reconstructions occurred in those with radiation, but was still successful in the majority of patients. Radiation had no influence on autologous tissue reconstruction major complication rates.
评估组织扩张器/植入物和自体组织乳房重建并发症的危险因素，并确定放射治疗是否会增加并发症发生率。
我们对克利夫兰诊所行乳房切除术加自体组织或扩张器/植入物重建的患者进行了回顾性研究。在每组中，我们进行了单因素和多因素分析，以评估并发症的危险因素。如果需要再次手术，则认为并发症为主要并发症。使用预测模型将两组进行比较。
本研究共纳入 1037 例患者。在组织扩张器/植入物人群中，总并发症发生率为 31.8%，总体主要并发症发生率为 24.4%。放射治疗使主要并发症发生率从 21.2%增加到 45.4%。然而，70.1%的放射治疗患者最终成功进行了基于植入物的重建，另外 10.3%的患者进行了自体重建。年龄和体重指数（BMI）>30 也导致组织扩张器/植入物重建的主要并发症发生率更高，而吸烟、高血压和化疗则没有影响。在自体重建组中，总并发症发生率为 31.5%，主要并发症发生率为 19.7%。放射治疗和非放射治疗的自体组织重建之间的主要并发症发生率无统计学差异，分别为 17.9%和 20.5%。BMI>30 是导致自体重建主要并发症的唯一显著因素。
组织扩张器和自体重建的总并发症发生率相似。组织扩张器重建患者的主要并发症发生率增加发生在接受放射治疗的患者中，但大多数患者仍成功。放射治疗对自体组织重建的主要并发症发生率没有影响。
