Breast Surgery Unit, Belfast Health and Social Care Trust, Belfast City Hospital, Level 2, 51 Lisburn Road, Belfast BT9 7AB, United Kingdom.
J Plast Reconstr Aesthet Surg. 2013 Sep;66(9):1188-94. doi: 10.1016/j.bjps.2013.04.048. Epub 2013 May 8.
Immediate reconstruction following mastectomy for breast cancer has been shown to be oncologically safe and associated with improved psychosocial outcomes for patients. Bostwick described a technique for one-stage implant based reconstruction, combining skin-sparing mastectomy with concurrent reduction of the skin envelope. This report reviews the experience of a single centre using skin-reducing mastectomy and one-stage implant reconstruction in both early stage breast cancer and risk-reducing mastectomy, with specific reference to frequency of complications, implant loss and oncological outcomes.
A retrospective review was undertaken to identify women who had undergone skin-reducing mastectomy and one-stage implant reconstruction using a de-epithelialised dermal flap, between October 2008 and October 2012. One hundred and four consecutive mastectomies, with reconstruction, were performed by two surgeons on 64 patients. No complications were seen in 43.8% of patients. At three months, four implants were lost (3.8% of breast reconstructions, 6.3% of patients), due to either peri-implant infection or mastectomy skin flap necrosis. One patient required unplanned return to theatre for evacuation of a haematoma. Minor mastectomy skin flap necrosis was seen in 10 breasts (9.6% of reconstructed breasts) and superficial wound infection in 8 breasts (7.7% of reconstructed breasts). All of these complications were managed conservatively and none required operative intervention. At a median follow up of 35 months (4-53 months) there had been one episode of ipsilateral axillary nodal recurrence.
One-stage implant reconstruction using a myo-dermal flap technique following skin-reducing mastectomy is safe and should be considered in selected patients. Most complications are minor and will resolve with conservative management. Major complications such as implant failure or immediate reoperation, were relatively uncommon (6.3% patients, 3.8% of reconstructed breasts). Early follow-up suggests that oncological outcomes are satisfactory, but longer follow-up is required to substantiate this.
乳腺癌乳房切除术后即刻重建已被证明具有肿瘤学安全性，并可改善患者的社会心理结局。Bostwick 描述了一种一期植入物重建技术，将保留皮肤的乳房切除术与同期缩小皮肤包膜相结合。本报告回顾了一家中心使用皮肤缩小乳房切除术和一期植入物重建的经验，包括早期乳腺癌和降低风险的乳房切除术，具体参考了并发症、植入物丢失和肿瘤学结果的频率。
回顾性分析 2008 年 10 月至 2012 年 10 月期间，两位外科医生使用去上皮真皮瓣对 64 例患者进行的 104 例连续乳房切除术和一期植入物重建。43.8%的患者无并发症。术后 3 个月，4 个植入物丢失（占乳房重建的 3.8%，占患者的 6.3%），原因是植入物周围感染或乳房切除术皮瓣坏死。1 例患者因血肿需计划返回手术室。10 例乳房（重建乳房的 9.6%）出现轻微的乳房皮瓣坏死，8 例乳房（重建乳房的 7.7%）出现浅表伤口感染。所有这些并发症均经保守治疗，无需手术干预。中位随访 35 个月（4-53 个月）时，同侧腋窝淋巴结复发 1 例。
皮肤缩小乳房切除术后使用肌皮瓣技术进行一期植入物重建是安全的，应考虑在选择的患者中进行。大多数并发症是轻微的，经保守治疗即可解决。严重并发症，如植入物失败或立即再次手术，相对少见（6.3%的患者，3.8%的重建乳房）。早期随访提示肿瘤学结果令人满意，但需要更长时间的随访来证实这一点。
