Susarla Srinivas M, Ganske Ingrid, Helliwell Lydia, Morris Donald, Eriksson Elof, Chun Yoon S
Baltimore, Md.; and Boston, Mass. From the Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital; the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Maryland Medical Center; the Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital; and Longwood Plastic Surgery.
Plast Reconstr Surg. 2015 Jan;135(1):1e-8e. doi: 10.1097/PRS.0000000000000803.
The purpose of this study was to assess the outcomes of immediate, single-stage, implant-based reconstruction compared with traditional, two-stage reconstruction (i.e., tissue expander placement followed by exchange to implant).
A retrospective review of consecutive patients who underwent immediate unilateral or bilateral breast reconstruction over an 8-year period was performed. The primary predictor variable was method of reconstruction (single-stage versus two-stage). Outcome measures were postoperative complication rates, revision rates, and BREAST-Q patient satisfaction scores. Descriptive, bivariate, and multiple regression statistics were computed.
The study sample consisted of 346 subjects who underwent reconstruction of 582 breasts (166 single-stage and 416 two-stage reconstructions). Complication rates between the single-stage and two-stage groups were similar for minor infections, major infections, hematoma formation, seroma formation, minor necrosis, and major necrosis (p ≥ 0.20). In a multiple logistic regression model, subjects undergoing single-stage reconstruction were found to be 87 percent more likely to require revision necessitating an additional operation (p = 0.005). In an adjusted regression model, subjects undergoing two-stage reconstruction had higher BREAST-Q scores for satisfaction with medical and office staff (p ≤ 0.02). Subjects undergoing single-stage reconstruction had higher sexual well-being satisfaction scores.
There is no significant difference in complication rates between single-stage versus two-stage implant-based breast reconstructions. Although single-stage reconstruction is associated with higher sexual well-being satisfaction, it is more than 80 percent more likely to require additional operative revisions. Two-stage reconstruction is associated with significantly higher satisfaction with the medical and office staff.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
本研究的目的是评估与传统的两阶段重建（即先放置组织扩张器，随后更换为植入物）相比，即刻单阶段植入物重建的效果。
对连续8年接受即刻单侧或双侧乳房重建的患者进行回顾性研究。主要预测变量是重建方法（单阶段与两阶段）。结果指标为术后并发症发生率、修复率和BREAST-Q患者满意度评分。计算描述性、双变量和多元回归统计数据。
研究样本包括346名接受582例乳房重建的受试者（166例单阶段重建和416例两阶段重建）。单阶段和两阶段组在轻微感染、严重感染、血肿形成、血清肿形成、轻微坏死和严重坏死方面的并发症发生率相似（p≥0.20）。在多元逻辑回归模型中，发现接受单阶段重建的受试者需要进行额外手术修复的可能性高87%（p = 0.005）。在调整后的回归模型中，接受两阶段重建的受试者对医疗和办公室工作人员的满意度BREAST-Q评分更高（p≤0.02）。接受单阶段重建的受试者在性健康满意度评分方面更高。
单阶段与两阶段植入物乳房重建的并发症发生率无显著差异。尽管单阶段重建与更高的性健康满意度相关，但它需要额外手术修复的可能性高出80%以上。两阶段重建与对医疗和办公室工作人员的显著更高满意度相关。
临床问题/证据水平：治疗性，III级。
