Liu Chunjun, Momeni Arash, Zhuang Yan, Luan Jie, Chung Michael T, Wright Eric, Lee Gordon K
Peking Union Medical College, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Palo Alto, CA, USA.
Ann Surg Oncol. 2014 Jun;21(6):2074-82. doi: 10.1245/s10434-014-3521-0. Epub 2014 Feb 21.
Expander-implant breast reconstruction (EIBR) and microsurgical abdominal flap breast reconstruction (MAFBR) are currently the two most frequent breast reconstruction techniques performed in the United States. The aim of this study was to compare outcomes between EIBR and MAFBR in order to help future breast cancer patients to be more knowledgeable and better informed in choosing their optimal reconstruction option.
Medical records of 795 patients who underwent breast reconstruction at Stanford Hospital from 2007 to 2011 were reviewed. We found 254 patients to be candidates for both MAFBR and EIBR preoperatively and included them in the study. Patients demographics, postoperative clinic visits, length of hospital stay, postoperative complications, and follow-up time were compared. Logistic regression analysis was used to determine risk factors for major complications.
MAFBR patients had 8.7 clinic visits postoperatively, while 14.6 visits were needed for EIBR patients. Length of hospital stay was 4.8 ± 1.32 days for MAFBR and 2.1 ± 0.9 days for EIBR. Complication occurred in 21.3 % of MAFBR versus 37.4 % for EIBR patients. Follow-up duration was 24.7 ± 17.2 months for EIBR and 30.1 ± 18.5 months for MAFBR. On multivariate analysis, EIBR and a body mass index of ≥30 kg/m(2) were the only significant predictors of major complication.
For patients eligible for both options, MAFBR has a lower incidence of major complications and fewer postoperative visits, but it has a longer initial hospital stay compared to EIBR. Patients should be informed of not only short-term but also long-term possible risks and benefits in order to make an informed decision.
扩张器-植入物乳房重建术（EIBR）和显微外科腹壁皮瓣乳房重建术（MAFBR）是目前美国最常用的两种乳房重建技术。本研究旨在比较EIBR和MAFBR的手术效果，以帮助未来的乳腺癌患者在选择最佳重建方案时能更了解情况并做出更明智的决策。
回顾了2007年至2011年在斯坦福医院接受乳房重建的795例患者的病历。我们发现254例患者术前符合MAFBR和EIBR两种手术的条件，并将他们纳入研究。比较了患者的人口统计学特征、术后门诊就诊情况、住院时间、术后并发症及随访时间。采用逻辑回归分析确定主要并发症的危险因素。
MAFBR患者术后门诊就诊次数为8.7次，而EIBR患者需要14.6次。MAFBR的住院时间为4.8±1.32天，EIBR为2.1±0.9天。MAFBR患者并发症发生率为21.3%，EIBR患者为37.4%。EIBR的随访时间为24.7±17.2个月，MAFBR为30.1±18.5个月。多因素分析显示，EIBR和体重指数≥30kg/m²是主要并发症的唯一显著预测因素。
对于符合两种手术条件的患者，MAFBR的主要并发症发生率较低，术后就诊次数较少，但与EIBR相比，其初始住院时间较长。应告知患者短期和长期可能存在的风险及益处，以便他们做出明智的决定。
