Lexington, Ky. From the University of Kentucky College of Medicine and the Division of Plastic Surgery and the Department of Surgery, University of Kentucky.
Plast Reconstr Surg. 2012 Feb;129(2):234e-241e. doi: 10.1097/PRS.0b013e31823aec7f.
Attempts to identify risk factors for adverse outcome following skin-sparing mastectomy and immediate prosthetic reconstruction have yielded inconsistent results, and no clear patient selection criteria have emerged. The authors identified patient- and procedure-related characteristics that predict unfavorable postoperative outcomes. Knowledge of these risk factors will facilitate preoperative patient screening to reduce the rate of implant loss and other postoperative complications.
The authors retrospectively evaluated the postoperative outcomes of implant loss and major and minor complications in 102 patients (155 breasts) undergoing the combined operation from January of 2005 to December of 2010. Univariate logistic regression analysis was performed to determine the influence of six patient-related and three procedure-related characteristics on implant loss and postoperative complications.
The use of acellular dermis was associated with a greater than three-fold increased risk of postoperative complications. Radiotherapy exposure was found to have a significant association with implant loss. None of the patient-related characteristics studied behaved as risk factors for postoperative complications, and none of the procedure-related characteristics acted as risk factors for implant loss.
A cautious and conservative approach to using acelluar dermal matrix in this setting is warranted until its effect on postoperative outcomes is more clearly defined. The authors' data support findings from other studies of the deleterious effect of breast radiotherapy on postoperative outcomes.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, IV.
尝试识别保乳手术后和即刻假体重建后不良结果的风险因素，结果不一致，也没有出现明确的患者选择标准。作者确定了预测术后不良结果的患者和手术相关特征。了解这些危险因素将有助于术前患者筛选，以降低假体丢失和其他术后并发症的发生率。
作者回顾性评估了 2005 年 1 月至 2010 年 12 月期间接受联合手术的 102 例（155 例乳房）患者的假体丢失和主要及次要并发症的术后结果。采用单因素逻辑回归分析确定 6 项患者相关特征和 3 项手术相关特征对假体丢失和术后并发症的影响。
使用脱细胞真皮与术后并发症的风险增加三倍以上有关。放射治疗暴露与假体丢失有显著关联。研究中的任何患者相关特征均未表现为术后并发症的危险因素，也没有任何手术相关特征表现为假体丢失的危险因素。
在这种情况下，使用脱细胞真皮基质需要谨慎和保守，直到其对术后结果的影响更加明确。作者的数据支持其他研究关于乳腺癌放疗对术后结果的有害影响的发现。
临床问题/证据水平：风险，IV。
