Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark.
Acta Oncol. 2011 Oct;50(7):1045-52. doi: 10.3109/0284186X.2011.581690. Epub 2011 May 23.
The number of women suitable for breast conserving treatment as well as immediate reconstruction after breast cancer has been increasing, and studies of complications hereafter are needed.
The cohort was identified in the prospective database of the Danish Registry for Plastic Surgery of the Breast during the period 1999 to 2006; 167 women with 189 immediate breast reconstructions (40 one-stage and 149 two-stage procedures) after breast cancer without a history of radiation therapy. The women were followed for complications until November 2009. Cumulative incidence risks were computed for infection, hematoma, seroma, severe capsular contracture (modified Baker III and IV), extrusion of the implant, implant rupture, asymmetry/displacement of the implant, any complication, and reoperation. In addition, we compared the postoperative course of immediate two-stage procedures with delayed two-stage procedures.
The overall eight-year risk estimates for the immediate procedures were 76.4% for any complication, 5.3% for severe capsular contracture, 29.5% for displacement/asymmetry of the implant and 40.6% for reoperation. Significantly higher risk for reoperation was observed after immediate one-stage than after two-stage procedures. For immediate two-stage procedures acute complications such as infection, seroma and hematoma were higher in the expansion period than after the second planned surgery. Higher risks for acute complications were observed after immediate than after delayed two-stage procedures.
Immediate breast implant reconstruction was found to have substantial risks of complications in non-radiated women, which should be considered in the guidance of breast cancer patients before choosing reconstructive procedure.
适合保乳治疗和乳腺癌后即刻重建的女性数量不断增加，因此需要研究此后的并发症。
该队列是在 1999 年至 2006 年期间在丹麦乳房整形手术注册处的前瞻性数据库中确定的；共有 167 名女性在乳腺癌后接受了 189 例即刻乳房重建（40 例一期和 149 例二期手术），且这些女性均无放疗史。对这些女性进行了随访，以了解并发症情况，随访截至 2009 年 11 月。计算了感染、血肿、血清肿、严重包膜挛缩（改良 Baker III 和 IV 级）、植入物外露、植入物破裂、植入物移位/不对称、任何并发症和再次手术的累积发生率风险。此外，我们还比较了即刻二期和延迟二期手术后的过程。
即刻手术 8 年的总体风险估计为：任何并发症为 76.4%，严重包膜挛缩为 5.3%，植入物移位/不对称为 29.5%，再次手术为 40.6%。即刻一期手术的再次手术风险显著高于二期手术。对于即刻二期手术，在扩张期发生的急性并发症（如感染、血清肿和血肿）比第二次计划手术时更高。即刻手术比延迟二期手术的急性并发症风险更高。
在未接受放疗的女性中，即刻乳房植入重建存在较高的并发症风险，在指导乳腺癌患者选择重建手术前应考虑这些风险。
