Momoh Adeyiza O, Colakoglu Salih, de Blacam Catherine, Gautam Shiva, Tobias Adam M, Lee Bernard T
Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
Ann Plast Surg. 2012 Jul;69(1):14-8. doi: 10.1097/SAP.0b013e31821ee4b6.
The optimal time for delayed autologous breast reconstruction after postmastectomy radiation therapy (PMRT) is unknown. Although most reconstructive surgeons recommend waiting for 6 months, this timing is arbitrary. A retrospective analysis was performed of 199 patients undergoing delayed autologous reconstruction; 100 patients had prior PMRT, whereas 99 patients had no previous radiation. Radiated patients had higher overall complications (40% vs. 20.2%, P = 0.0023), including wound dehiscence (11% vs. 3%, P = 0.049), and trended toward increased postsurgical infections (7% vs. 1%, P = 0.065). Logistic regression models of unequally distributed variables found radiation therapy to be the only independent risk factor for wound dehiscence (odds ratio, 3.97; P = 0.04). Mean follow-up for radiated and nonradiated patients was 33.3 months and 39.4 months, respectively. After PMRT, 17 patients were reconstructed within 6 months and 83 after 6 months. No significant differences in complications were observed between these groups. An alternate analysis examined 51 patients reconstructed within 12 months of PMRT and 49 patients reconstructed after; again, there were no differences in complications. As overall complications are similar in patients reconstructed early or late after PMRT, autologous breast reconstruction can potentially be performed earlier than is the current accepted practice.
乳房切除术后放疗（PMRT）后延迟自体乳房重建的最佳时间尚不清楚。尽管大多数重建外科医生建议等待6个月，但这个时间是随意确定的。对199例行延迟自体重建的患者进行了回顾性分析；100例患者曾接受过PMRT，而99例患者之前未接受过放疗。接受放疗的患者总体并发症发生率更高（40%对20.2%，P = 0.0023），包括伤口裂开（11%对3%，P = 0.049），且术后感染有增加趋势（7%对1%，P = 0.065）。对分布不均的变量进行逻辑回归模型分析发现，放疗是伤口裂开的唯一独立危险因素（比值比，3.97；P = 0.04）。接受放疗和未接受放疗患者的平均随访时间分别为33.3个月和39.4个月。PMRT后，17例患者在6个月内进行了重建，83例在6个月后进行了重建。两组之间在并发症方面未观察到显著差异。另一项分析检查了51例在PMRT后12个月内进行重建的患者和49例在之后进行重建的患者；同样，并发症方面也没有差异。由于PMRT后早期或晚期进行重建的患者总体并发症相似，自体乳房重建可能可以比目前公认的做法更早进行。
