分析从植入物为基础的乳房重建转为完全自体乳房重建的动机和风险因素。

An analysis of the motivating and risk factors for conversion from implant-based to total autologous breast reconstruction.

机构信息

Newcastle-upon-Tyne, United Kingdom From the Department of Plastic and Reconstructive Surgery, The Newcastle NHS Trust.

出版信息

Plast Reconstr Surg. 2013 Jul;132(1):23-33. doi: 10.1097/PRS.0b013e318290f83e.

DOI:10.1097/PRS.0b013e318290f83e

PMID:23806906

Abstract

BACKGROUND

Problems with implant-based breast reconstructions can lead to patient dissatisfaction and a request for total autologous reconstruction. This 12-year study aimed to determine the rate of conversion from implant-based to autologous reconstruction, to identify potential risk factors, compare the rate of conversion in implant-only and latissimus dorsi/implant reconstructions, and assess patient satisfaction following conversion.

METHODS

Implant-based reconstructions performed between 2000 and 2008 were reviewed. The cohort was then followed prospectively until 2012.

RESULTS

One hundred thirty-nine implant-based reconstructions were performed in 118 patients. Sixty-nine patients underwent latissimus dorsi/implant (80 breasts) and 49 underwent implant-only reconstructions (59 breasts). Twenty-one underwent bilateral reconstructions following risk-reduction surgery. Sixteen percent (19 of 118) of patients and 14 percent of breasts (19 of 139) underwent conversion to autologous tissue. None of the 21 bilateral cases converted (hazard ratio, 4.6; p < 0.05). Median time to conversion was 64 months (range, 18 to 142 months). The main motivating factors for conversion included poor aesthetic result (36.8 percent), capsular contracture (31.6 percent), change in weight (21.1 percent), and implant infection/extrusion (10.5 percent). Implant-only reconstructions were more likely to convert (hazard ratio, 3.6; p < 0.05) and at an earlier stage (p < 0.05) than latissimus dorsi/implant reconstructions. Neither radiotherapy (p = 0.68) nor capsular contracture (p = 0.94) significantly increased the risk of conversion. The BREAST-Q demonstrated high patient satisfaction after conversion.

CONCLUSIONS

Autologous tissue conversion offers a definitive means of improving the quality of the result, patient satisfaction, and quality of life in troublesome implant-based breast reconstructions. Latissimus dorsi coverage of implants and bilateral reconstructions appear to be protective.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

摘要

背景

植入物乳房重建出现问题会导致患者不满意并要求进行完全自体组织重建。这项为期 12 年的研究旨在确定从植入物乳房重建转为自体组织乳房重建的比率，确定潜在的风险因素，比较单纯植入物重建和背阔肌/植入物重建的转换率，并评估转换后的患者满意度。

方法

回顾了 2000 年至 2008 年期间进行的植入物乳房重建。然后前瞻性地随访该队列，直到 2012 年。

结果

118 例患者共进行了 139 例植入物乳房重建。69 例患者接受了背阔肌/植入物（80 个乳房），49 例患者接受了单纯植入物重建（59 个乳房）。21 例患者在接受降低风险手术后进行了双侧重建。16%（19/118）的患者和 14%的乳房（19/139）接受了自体组织重建。没有双侧病例发生转换（风险比，4.6；p<0.05）。转换的中位时间为 64 个月（范围，18 至 142 个月）。转换的主要动机因素包括美容效果差（36.8%）、包膜挛缩（31.6%）、体重变化（21.1%）和植入物感染/外露（10.5%）。单纯植入物重建更有可能发生转换（风险比，3.6；p<0.05），且转换时间更早（p<0.05）。放射治疗（p=0.68）和包膜挛缩（p=0.94）均未显著增加转换的风险。BREAST-Q 在转换后显示出患者高度满意。