Chicago, Ill. From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine.
Plast Reconstr Surg. 2014 Nov;134(5):692e-699e. doi: 10.1097/PRS.0000000000000607.
Expander/implant breast reconstruction is a common approach to breast reconstruction. Although several studies evaluate risk factors for complications during the overall reconstructive process, no studies currently evaluate risk factors by stage of reconstruction. This information is important, as it can help guide physician and patient decision making.
This is a retrospective review of the records of 876 patients who underwent expander/implant breast reconstruction. Average follow-up time was 42 months. Multivariate analysis and odds ratios were used to calculate the significance of the variables of interest and to compare the risk of complications attributable to each of the independent variables during each stage of the procedure.
During the expander stage, body mass index greater than 30 kg/m had the strongest effect on the development of complications leading to explantation/conversion to flap (OR, 3.07). During the permanent implant stage, history of prereconstruction irradiation had the strongest association with the development of complications leading to explantation/conversion to flap (OR, 3.45). The only risk factors that had a statistically significant effect on the development of complications during both stages were age older than 50 years, smoking within the past month, and a history of premastectomy or postmastectomy radiation therapy.
The results of this study indicate that the risk factors for complications during expander/implant breast reconstruction differ during each stage of the procedure. The individual impact of risk factors must be considered within the context of each patient's oncologic and surgical needs so that surgeons and patients may make more informed decisions toward their goal of a successful breast reconstruction.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
扩张器/植入物乳房重建是乳房重建的常用方法。尽管有几项研究评估了整个重建过程中并发症的风险因素，但目前尚无研究按重建阶段评估风险因素。这些信息很重要，因为它可以帮助指导医生和患者做出决策。
这是对 876 名接受扩张器/植入物乳房重建的患者记录的回顾性研究。平均随访时间为 42 个月。使用多变量分析和优势比来计算感兴趣变量的显著性，并比较每个阶段程序中每个独立变量引起并发症的风险。
在扩张器阶段，BMI 大于 30kg/m2 对导致乳房假体取出/转换为皮瓣的并发症发展的影响最大（OR，3.07）。在永久性植入物阶段，重建前放疗史与导致乳房假体取出/转换为皮瓣的并发症发展的相关性最强（OR，3.45）。在两个阶段都对并发症发展有统计学显著影响的唯一风险因素是年龄大于 50 岁、过去一个月内吸烟以及有乳房切除术或乳房切除术放疗史。
本研究结果表明，扩张器/植入物乳房重建过程中并发症的风险因素在每个阶段都不同。必须在每个患者的肿瘤学和手术需求背景下考虑风险因素的个体影响，以便外科医生和患者能够就成功的乳房重建目标做出更明智的决策。
临床问题/证据水平：风险，III。
