全皮瓣保留乳房切除术切口类型对放疗后重建并发症的影响。
Impact of total skin-sparing mastectomy incision type on reconstructive complications following radiation therapy.
机构信息
San Francisco, Calif.; and Durham, N.C. From the Divisions of Plastic and Reconstructive Surgery and Breast Surgery, Department of Surgery, and the Department of Radiation Oncology, University of California, San Francisco; and the School of Medicine, Duke University.
出版信息
Plast Reconstr Surg. 2014 Aug;134(2):169-175. doi: 10.1097/PRS.0000000000000386.
BACKGROUND
Postoperative complications after total skin-sparing mastectomy and expander-implant reconstruction can negatively impact outcomes, particularly in the setting of postmastectomy radiation therapy. The authors studied whether rates of ischemic complications after postmastectomy radiation therapy are impacted by the total skin-sparing mastectomy incision.
METHODS
The authors queried a prospectively collected database of patients undergoing total skin-sparing mastectomy and immediate two-stage expander-implant reconstruction. Their hypothesis was that, in the setting of radiation therapy, patients with inframammary incisions would be more likely to develop ischemic complications than those without incisions on the dependent portion of the breast. We divided our patient cohort into two groups, those with inframammary incisions and those with other incisions, and then analyzed the proportion that received radiation therapy.
RESULTS
Of 756 cases included in the analysis, 91 (12 percent) received postmastectomy radiation therapy, 62 (68.1 percent) with inframammary incisions and 29 (31.9 percent) with other incisions. Mean follow-up was 3.1 years. Rates of mastectomy skin flap necrosis (3.2 percent versus 6.9 percent, p=0.4) following radiation therapy were not significantly higher in the inframammary group. However, breakdown of the total skin-sparing mastectomy incision was twice as likely in the inframammary group (21 percent versus 10.3 percent, p=0.2) and was more likely to lead to subsequent implant removal when incisional breakdown occurred (77 percent versus 0 percent, p=0.03).
CONCLUSIONS
Total skin-sparing mastectomy incision type may impact rates of incisional breakdown and implant loss following postmastectomy radiation therapy, with higher rates seen with inframammary incisions. Multiple factors, including breast size, breast ptosis, and likelihood of radiation therapy, should be considered in determining optimal incision.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
背景
全皮保留乳房切除术和扩张器-植入物重建术后的并发症会对结果产生负面影响，尤其是在接受乳房切除术后放疗的情况下。作者研究了在接受乳房切除术后放疗的情况下，总皮保留乳房切除术切口是否会影响缺血性并发症的发生率。
方法
作者查询了接受全皮保留乳房切除术和即刻两阶段扩张器-植入物重建的患者前瞻性收集的数据库。他们的假设是，在放疗的情况下，乳晕切口的患者比乳房下侧无切口的患者更有可能发生缺血性并发症。我们将患者队列分为两组，一组有乳晕切口，另一组有其他切口，然后分析接受放疗的比例。
结果
在纳入分析的 756 例患者中，91 例（12%）接受了乳房切除术放疗，其中 62 例（68.1%）有乳晕切口，29 例（31.9%）有其他切口。平均随访时间为 3.1 年。在接受放疗的患者中，乳房皮瓣坏死的发生率（3.2%比 6.9%，p=0.4）在乳晕组中并没有显著更高。然而，乳晕组全皮保留乳房切除术切口裂开的可能性是两倍（21%比 10.3%，p=0.2），当切口裂开发生时，更有可能导致随后的植入物取出（77%比 0%，p=0.03）。
结论
全皮保留乳房切除术切口类型可能会影响乳房切除术后放疗后的切口裂开和植入物丢失率，乳晕切口的发生率较高。在确定最佳切口时，应考虑多个因素，包括乳房大小、乳房下垂和放疗的可能性。
临床问题/证据水平：治疗，III。
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