Georgetown University Hospital, Department of Plastic Surgery, Washington, DC, USA.
Georgetown University Hospital, Department of Surgery, Washington, DC, USA.
J Plast Reconstr Aesthet Surg. 2014 Apr;67(4):477-82. doi: 10.1016/j.bjps.2013.12.049. Epub 2014 Jan 4.
Delayed-immediate reconstruction is an increasingly valuable algorithm for patients anticipating post-mastectomy radiation therapy. Despite the cosmetic and long-term advantages of autologous tissue repair, a subset of patients choose implant-based reconstruction after their initial preference for autologous reconstruction. A critical evaluation of patients who initially planned to undergo delayed-immediate reconstruction but later chose to continue with implant-based reconstruction has not been previously reported. A retrospective analysis of the senior author's (M.Y.N.) patients who initially intended to undergo delayed-immediate autologous breast reconstruction following mastectomy and chose to abandon autologous reconstruction in favour of prosthetic reconstruction was completed from 2005 to 2011. Seven patients (10 breasts) met inclusion criteria. The mean patient age and body mass index were 50.2 years and 32.1 kg m(-2), respectively. Expansion required an average of 4.4 office visits to achieve adequate expansion volume, mean 483 ml (240-600 ml). The mean time from expander placement to definitive reconstruction was 14.6 months. Mean follow-up time was 20.4 months. Complications included infection (1/7), incisional dehiscence (1/7) and capsular contracture (2/7), and late revision surgery was performed in two patients. Successful reconstruction was achieved in 100% of patients (7/7) with a patient-reported satisfaction of 100%. Patient motivations for changing the reconstructive algorithm included a faster post-operative recovery in four patients (4/7) and potential donor-site morbidity in three patients (3/7). Depression or cancer-related fatigue symptoms were self-reported in 4/7. Avoiding donor-site morbidity and a simpler recovery are the main factors that influence patients to change their desire for autologous reconstruction to an implant-based reconstruction. Cancer-related fatigue and depression are prevalent in this population and may be implicated in a patient's desire to undergo less extensive reconstructive surgery. Allowing for the choice of definitive implant-based reconstruction in select patients is safe and is likely to result in high patient satisfaction with satisfactory aesthetic outcomes.
延迟即刻重建是一种对接受乳房切除术后放疗的患者越来越有价值的算法。尽管自体组织修复具有美容和长期优势，但一部分患者在最初选择自体重建后，选择了基于植入物的重建。之前没有报道过对最初计划接受延迟即刻重建但后来选择继续进行基于植入物的重建的患者进行批判性评估。对高级作者（M.Y.N.）的患者进行了回顾性分析，这些患者最初计划在乳房切除术后接受延迟即刻自体乳房重建，但后来选择放弃自体重建而采用假体重建，研究时间从 2005 年至 2011 年。7 名患者（10 只乳房）符合纳入标准。患者的平均年龄和体重指数分别为 50.2 岁和 32.1kg/m²。扩张平均需要 4.4 次就诊才能达到足够的扩张体积，平均 483ml（240-600ml）。从扩张器放置到确定性重建的平均时间为 14.6 个月。平均随访时间为 20.4 个月。并发症包括感染（1/7）、切口裂开（1/7）和包膜挛缩（2/7），两名患者进行了晚期修复手术。100%（7/7）的患者成功重建，患者报告满意度为 100%。患者改变重建方案的动机包括 4 名患者（4/7）术后恢复更快和 3 名患者（3/7）潜在的供区发病率。4/7 名患者报告有抑郁或癌症相关疲劳症状。避免供区发病率和更简单的恢复是影响患者将对自体重建的渴望转变为基于植入物重建的主要因素。癌症相关疲劳和抑郁在这一人群中很常见，可能与患者渴望进行不太广泛的重建手术有关。允许选择特定患者进行确定性基于植入物的重建是安全的，并且可能会导致患者对美学结果非常满意。
