Department of Plastic and Aesthetic Surgery, Sana Hospital Duesseldorf, Duesseldorf, Germany.
Med Sci Monit. 2013 Jun 17;19:467-74. doi: 10.12659/MSM.883954.
Bilateral breast reconstruction utilising autologous free tissue transfer is a complex procedure with multiple options for donor tissue available. Autogenous breast reconstruction techniques have evolved over the last three decades to meet this goal. The aim of this study was to determine the outcomes of patients undergoing bilateral breast reconstruction with DIEAP, TRAM or SIEA flaps.
A prospective study was performed in our Interdisciplinary Breast Centre from July 2004 until December 2011 in 144 patients. Demographic information, diabetes mellitus type I status, tobacco use, tumor stage, primary/secondary reconstruction, operative technique, adjuvant therapy received, length of follow-up, and complications were evaluated. Complications were divided into donor site and recipient site. To investigate which risk factors were independently related to flap loss (complete or partial), multiple linear regression analysis was performed.
The study identified 144 patients who had bilateral breast reconstruction with DIEAP, TRAM or SIEA flaps. For all flaps (n=248), outcome included 98.4% survival and 0.7% vein microanastomosis revision. Recipient site complications included 1.6% complete flap loss, 0.8% fat necrosis, 2.9% partial skin loss/dehiscence flap necrosis and 2.0% haematoma rate. Donor site complications included 3.7% partial skin loss/dehiscence. There was evidence of abdominal bulges in TRAM patients (1.1%) but no hernias in any patients. BMI is a major determinant of flap loss (complete or partial) in these patients.
The primary goal of bilateral breast reconstruction is to provide a treatment option that can create a natural, symmetric breast mounds with minimal donor-site morbidity following bilateral mastectomies. These results support weight loss therapy prior to bilateral breast reconstruction.
利用游离组织自体移植进行双侧乳房重建是一项复杂的手术，有多种供区组织可供选择。 自体乳房重建技术在过去三十年中不断发展，以实现这一目标。 本研究旨在确定接受 DIEAP、TRAM 或 SIEA 皮瓣双侧乳房重建的患者的结果。
2004 年 7 月至 2011 年 12 月，我们在跨学科乳房中心对 144 例患者进行了前瞻性研究。评估了人口统计学信息、I 型糖尿病状态、吸烟、肿瘤分期、原发性/继发性重建、手术技术、接受的辅助治疗、随访时间和并发症。并发症分为供区和受区。为了研究哪些危险因素与皮瓣丢失（完全或部分）独立相关，进行了多元线性回归分析。
该研究确定了 144 例接受 DIEAP、TRAM 或 SIEA 皮瓣双侧乳房重建的患者。所有皮瓣（n=248）的结果包括 98.4%的存活率和 0.7%的静脉吻合修正率。受区并发症包括 1.6%的完全皮瓣坏死、0.8%的脂肪坏死、2.9%的部分皮肤坏死/皮瓣坏死和 2.0%的血肿发生率。供区并发症包括 3.7%的部分皮肤坏死/皮瓣坏死。TRAM 患者有腹部膨出的证据（1.1%），但无任何患者发生疝。BMI 是这些患者皮瓣坏死（完全或部分）的主要决定因素。
双侧乳房重建的主要目标是提供一种治疗选择，在双侧乳房切除术后，既能创造自然、对称的乳房肿块，又能使供区并发症最小化。这些结果支持在双侧乳房重建前进行减肥治疗。
