Smith Mark L, Clarke-Pearson Emily M, Vornovitsky Michael, Dayan Joseph H, Samson William, Sultan Mark R
Department of Surgery, Mount Sinai Beth Israel, New York, NY, USA.
Department of Surgery, Mount Sinai St. Luke's-Roosevelt, New York, NY, USA.
Arch Plast Surg. 2014 Sep;41(5):535-41. doi: 10.5999/aps.2014.41.5.535. Epub 2014 Sep 15.
Patients having unilateral breast reconstruction often require a second stage procedure on the contralateral breast to improve symmetry. In order to provide immediate symmetry and minimize the frequency and extent of secondary procedures, we began performing simultaneous contralateral balancing operations at the time of initial reconstruction. This study examines the indications, safety, and efficacy of this approach.
One-hundred and two consecutive breast reconstructions with simultaneous contralateral balancing procedures were identified. Data included patient age, body mass index (BMI), type of reconstruction and balancing procedure, specimen weight, transfusion requirement, complications and additional surgery under anesthesia. Unpaired t-tests were used to compare BMI, specimen weight and need for non-autologous transfusion.
Average patient age was 48 years. The majority had autologous tissue-only reconstructions (94%) and the rest prosthesis-based reconstructions (6%). Balancing procedures included reduction mammoplasty (50%), mastopexy (49%), and augmentation mammoplasty (1%). Average BMI was 27 and average reduction specimen was 340 grams. Non-autologous blood transfusion rate was 9%. There was no relationship between BMI or reduction specimen weight and need for transfusion. We performed secondary surgery in 24% of the autologous group and 100% of the prosthesis group. Revision rate for symmetry was 13% in the autologous group and 17% in the prosthesis group.
Performing balancing at the time of breast reconstruction is safe and most effective in autologous reconstructions, where 87% did not require a second operation for symmetry.
进行单侧乳房重建的患者通常需要对侧乳房进行二期手术以改善对称性。为实现即时对称并尽量减少二次手术的频率和范围，我们开始在初次重建时同时进行对侧平衡手术。本研究探讨了该方法的适应证、安全性和有效性。
确定了102例连续进行对侧平衡手术的乳房重建病例。数据包括患者年龄、体重指数（BMI）、重建及平衡手术类型、标本重量、输血需求、并发症以及麻醉下的额外手术情况。采用非配对t检验比较BMI、标本重量和非自体输血需求。
患者平均年龄为48岁。大多数患者仅采用自体组织重建（94%），其余采用假体植入重建（6%）。平衡手术包括乳房缩小成形术（50%）、乳房上提术（49%）和隆乳术（1%）。平均BMI为27，平均切除标本重量为340克。非自体输血率为9%。BMI或切除标本重量与输血需求之间无相关性。自体组织组24%的患者和假体植入组100%的患者进行了二次手术。自体组织组对称性修复率为13%，假体植入组为17%。
在乳房重建时进行平衡手术是安全的，在自体组织重建中最为有效，其中87%的患者无需因对称性问题进行二次手术。
