Munhoz Alexandre Mendonça, Aldrighi Cláudia Maria, Montag Eduardo, Arruda Eduardo, Brasil José Augusto, Filassi José Roberto, Aldrighi José Mendes, Gemperli Rolf, Ferreira Marcus Castro
Division of Plastic Surgery, University of São Paulo School of Medicine, São Paulo, Brazil.
Ann Plast Surg. 2011 Sep;67(3):220-5. doi: 10.1097/SAP.0b013e3181f77bba.
Bilateral mammaplasty or mastopexy is frequently used for oncoplastic objectives. However, little information has been available regarding outcome following immediate and delayed reconstruction.
Patients were divided into Group I (immediate reconstruction) and Group II (delayed reconstruction). Retrospective review was performed to compare complications, length of hospital stay, revision surgeries, and satisfaction. The associations between the complications with potential risk factors (timing, age, body mass index, smoking, and comorbid medical conditions) were analyzed.
There were a total of 144 patients with a mean follow-up of 47 months. Of the 106 patients in Group I, complications occurred in 24 (22.6%), skin necrosis was observed in 7.5%, fat necrosis in 5.6%, and 6.6% patients developed local recurrence. Mean period of hospitalization was 1.89 days. Of the 38 patients of the Group II, complications occurred in 12 (31.5%), skin necrosis was observed in 7 (18.4%), fat necrosis in 4 (10.5%), and 5.2% patients developed local recurrence. Mean period of hospitalization was 1.35 days. Increased length of hospital stay greater than 1 day (P < 0.001) and the number of revision surgeries (P = 0.043) were associated with the timing of the reconstruction. In univariate analysis, no difference between groups was found with respect to complication incidence (P = 0.275); however, after adjusting for other risk factors, the probability of complications tend to be higher for Group II (OR = 2.65; 95% confidence interval = 1.01-7.00; P = 0.049).
On the basis of the results of our study, the probability of complications tends to be higher for delayed reconstructions, and it is demonstrated that obesity and smoking are risk factors for complications. Ultimately, these data may facilitate the provision of individualized risk information for shared medical decision-making.
双侧乳房成形术或乳房上提术常用于肿瘤整形目的。然而，关于即刻重建和延迟重建后的结果，可用信息较少。
患者分为I组（即刻重建）和II组（延迟重建）。进行回顾性分析以比较并发症、住院时间、修复手术和满意度。分析了并发症与潜在风险因素（时间、年龄、体重指数、吸烟和合并症）之间的关联。
共有144例患者，平均随访47个月。I组106例患者中，24例（22.6%）发生并发症，7.5%观察到皮肤坏死，5.6%发生脂肪坏死，6.6%的患者出现局部复发。平均住院时间为1.89天。II组38例患者中，12例（31.5%）发生并发症，7例（18.4%）观察到皮肤坏死，4例（10.5%）发生脂肪坏死，5.2%的患者出现局部复发。平均住院时间为1.35天。住院时间延长超过1天（P < 0.001）和修复手术次数（P = 0.043）与重建时间有关。单因素分析中，两组并发症发生率无差异（P = 0.275）；然而，在调整其他风险因素后，II组并发症发生概率倾向于更高（OR = 2.65；95%置信区间 = 1.01 - 7.00；P = 0.049）。
根据我们的研究结果，延迟重建的并发症发生概率倾向于更高，并且表明肥胖和吸烟是并发症的风险因素。最终，这些数据可能有助于提供个性化的风险信息，以进行共同的医疗决策。
