Cassileth Lisa, Kohanzadeh Som, Amersi Farin
Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Ann Plast Surg. 2012 Aug;69(2):134-8. doi: 10.1097/SAP.0b013e3182250c60.
The current standard of care for breast implant reconstruction after mastectomy is 2-stage reconstruction with placement of tissue expanders followed by implants. The immediate use of implants at the time of mastectomy, which eliminates the need for a second operative procedure, has been sparsely reported and is not yet accepted as the standard of care. This study describes a 1-stage immediate implant reconstruction technique and evaluates its risks.
Between 2005 and 2010, immediate implant reconstruction was performed in 43 sequential patients on a total of 78 breasts. Permanent silicone implants were placed at the time of mastectomy with the assistance of acellular dermal matrix (ADM). Follow-up was for an average of 575 days. Implant sizes varied widely from 175 to 800 mL. In order to create the correct breast shape and implant placement, specific techniques of acellular dermal matrix placement in the reconstruction were critically important. Aesthetic evaluation of the patients was performed, evaluating pre- and postoperative photos by 20 evaluators. Pictures were rated according to a 4-point Harris breast scale. A 2-sided paired t test was then used to compare the rating scores.
Complication rates were as follows: seroma occurred in 6.4% of breasts; infection resolving with antibiotics occurred in 2.6%; infection requiring implant removal occurred in 3.8%; and hematoma occurred in 1.3%. Neither preoperative breast size nor implant size correlated to an increased risk of complications (P>0.05). Complication rate increased with age (P=0.02). The average score for the preoperative images was 2.1, whereas the postoperative average was 2.4. This represented a statistically significant improvement above the baseline (preoperative) breasts with a P<0.001, according to a 2-sided paired t test.
With complication rates similar to previously reported tissue expander reconstructions, immediate implant reconstruction is a viable alternative to 2-stage expander reconstruction, presenting many advantages over expander reconstruction while offering the same risk profile and eliminating the additional risks, costs, and discomfort of a second procedure. Additionally, aesthetic results were highly satisfactory according to patients themselves and based on evaluation by independent observers.
乳房切除术后乳房植入物重建的当前护理标准是两阶段重建，即先放置组织扩张器，然后植入假体。乳房切除时立即使用假体，无需二次手术，相关报道较少，尚未被接受为护理标准。本研究描述了一种单阶段立即植入物重建技术并评估其风险。
2005年至2010年期间，连续43例患者共78个乳房接受了立即植入物重建。在乳房切除时，借助脱细胞真皮基质（ADM）放置永久性硅胶假体。平均随访575天。假体大小从175毫升到800毫升差异很大。为了塑造正确的乳房形状并确定假体位置，在重建中采用特定的脱细胞真皮基质放置技术至关重要。对患者进行美学评估，由20名评估者评估术前和术后照片。根据4分的哈里斯乳房量表对照片进行评分。然后使用双侧配对t检验比较评分。
并发症发生率如下：6.4%的乳房发生血清肿；2.6%的乳房发生使用抗生素后消退的感染；3.8%的乳房发生需要取出假体的感染；1.3%的乳房发生血肿。术前乳房大小和假体大小均与并发症风险增加无关（P>0.05）。并发症发生率随年龄增加而升高（P=0.02）。术前图像的平均评分为2.1，而术后平均评分为2.4。根据双侧配对t检验，这表明与基线（术前）乳房相比有统计学显著改善，P<0.001。
立即植入物重建的并发症发生率与先前报道的组织扩张器重建相似，是两阶段扩张器重建的可行替代方案，与扩张器重建相比具有许多优势，同时具有相同的风险特征，且消除了二次手术的额外风险、成本和不适。此外，根据患者自身以及独立观察者的评估，美学效果非常令人满意。
