术前放疗背景下组织扩张器/植入物乳房重建的结果。
Outcomes of tissue expander/implant breast reconstruction in the setting of prereconstruction radiation.
机构信息
Chicago, Ill. From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine.
出版信息
Plast Reconstr Surg. 2012 Feb;129(2):354-361. doi: 10.1097/PRS.0b013e31823ae8b1.
BACKGROUND
Although the effects of postoperative radiation on tissue expander breast reconstruction are well documented, few data exist regarding the effects of prereconstruction radiation. This study evaluates the outcomes of tissue expander breast reconstruction in women with prereconstruction radiation.
METHODS
This study retrospectively evaluated two treatments: (1) mastectomy without reconstruction followed by postoperative radiation and delayed reconstruction (10 patients) and (2) failed breast-conserving therapy (lumpectomy plus radiotherapy) necessitating mastectomy and immediate reconstruction (66 patients). Procedures were performed at Northwestern Memorial Hospital between August of 1999 and July of 2008. Average follow-up was 35 months.
RESULTS
In both groups, approximately 60 percent of patients successfully completed two stages of reconstruction. Overall complication rates, including major and minor complications, were 70 percent per reconstruction (37 percent first stage, 45 percent second stage) for immediate reconstruction and 50 percent per reconstruction (20 percent first stage, 38 percent second stage) for delayed reconstruction. No differences in complication rates were observed based on age, smoking status, body mass index, or timing between radiation and surgery (p > 0.05).
CONCLUSIONS
When discussing expander/implant reconstruction with patients who have a history of prior breast radiotherapy, a frank discussion of the risks, benefits, and alternatives should occur. If a 40 percent total explantation or conversion to flap rate is truly understood by the patient, and if immediate autologous breast reconstruction is to be avoided, then the patient may proceed with tissue expander breast reconstruction. For patients who wish to avoid additional scars or more invasive procedures, however, this study demonstrates that they have a 60 percent chance of success.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
背景
尽管术后放疗对组织扩张器乳房重建的影响已有充分的文献记载，但关于术前放疗的影响的数据却很少。本研究评估了术前放疗对组织扩张器乳房重建的影响。
方法
本研究回顾性评估了两种治疗方法：（1）先行乳房切除术而不进行重建，然后进行术后放疗和延迟重建（10 例）；（2） 保乳治疗失败（乳房切除术加放疗），需要行乳房切除术和即刻重建（66 例）。这些手术都是在 1999 年 8 月至 2008 年 7 月期间在西北纪念医院进行的。平均随访时间为 35 个月。
结果
在两组患者中，约有 60%的患者成功完成了两期重建。总体并发症发生率，包括主要和次要并发症，即刻重建为每例重建的 70%（第一期 37%，第二期 45%），延迟重建为每例重建的 50%（第一期 20%，第二期 38%）。两组之间，在年龄、吸烟状况、体重指数或放疗与手术之间的时间间隔等因素基础上，并发症发生率没有差异（p＞0.05）。
结论
在与有既往乳房放疗史的患者讨论扩张器/植入物重建时，应坦率地讨论风险、益处和替代方案。如果患者真正理解 40%的总取出率或转换为皮瓣的风险，并且如果要避免即刻自体乳房重建，那么患者可以进行组织扩张器乳房重建。但是，对于那些希望避免更多疤痕或更具侵袭性手术的患者，本研究表明他们有 60%的成功机会。
临床问题/证据水平：治疗性，III 级。
Zotero 插件