Kilgo Matthew S, Kaufman Gabriel J, Shen Allison E, Korsh Jessica, Baranchuk Nadia V, Douglas Barry K, Brewer Bruce W
East Meadow and Garden City, N.Y. From the Nassau University Medical Center and the Long Island Plastic Surgical Group.
Plast Reconstr Surg. 2015 Oct;136(4):426e-433e. doi: 10.1097/PRS.0000000000001574.
Patients with large or ptotic breasts undergoing mastectomy followed by tissue expander/implant-based reconstruction may benefit from a Wise (inverted-T) pattern reduction mammaplasty incision compared with the traditional horizontal elliptical incision. The authors compared these two groups of patients with regard to complication rates and outcomes.
Sixty-nine patients (117 breasts) were identified who underwent Wise pattern mastectomy and two-stage reconstruction. A control group of 89 patients (136 breasts) who underwent reconstruction after horizontal elliptical mastectomy were selected over the same period. Patient demographics, clinical characteristics, and complication rates were recorded and analyzed statistically.
Patient demographics (age, body mass index, diabetes, smoking, and irradiation history) and clinical characteristics (laterality, expander size and fill volume, and time to expansion) were similar, with the exception of body mass index (control, 26.7 kg/m; inverted-T, 28.7 kg/m; p = 0.04) and mean intraoperative fill volume (control, 158.7 cc; inverted-T, 196.9 cc; p = 0.02). Of all complications (infection, seroma, flap necrosis, expander loss, and salvage), only the rate of mastectomy flap necrosis was significantly greater (p = 0.002) in patients undergoing inverted-T mastectomy (25.6 percent versus 11.0 percent). This difference did not result in a significantly higher rate of expander loss or need for salvage surgery.
The inverted-T mastectomy approach can be performed safely with acceptable complication rates. When compared with an internal control group, complication rates were similar, with the exception of mastectomy flap necrosis. Despite a higher rate of flap necrosis, 91 percent of inverted-T patients successfully completed the expansion process.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
与传统的水平椭圆形切口相比，接受乳房切除术并采用组织扩张器/植入物重建的巨乳或下垂乳房患者可能从改良 Wise（倒 T 形）切口乳房缩小成形术中获益。作者比较了这两组患者的并发症发生率和治疗效果。
确定 69 例（117 个乳房）接受改良 Wise 式乳房切除术和两阶段重建的患者。同期选择 89 例（136 个乳房）接受水平椭圆形乳房切除术后重建的患者作为对照组。记录患者人口统计学资料、临床特征和并发症发生率，并进行统计学分析。
患者人口统计学资料（年龄、体重指数、糖尿病、吸烟和放疗史）和临床特征（患侧、扩张器大小和填充量以及扩张时间）相似，但体重指数（对照组 26.7kg/m；倒 T 形组 28.7kg/m；p = 0.04）和平均术中填充量（对照组 158.7cc；倒 T 形组 196.9cc；p = 0.02）除外。在所有并发症（感染、血清肿、皮瓣坏死、扩张器丢失和补救手术）中，仅改良 Wise 式乳房切除术患者的乳房切除皮瓣坏死率显著更高（p = 0.002）（25.6%对 11.0%）。这种差异并未导致扩张器丢失率显著升高或补救手术需求增加。
改良 Wise 式乳房切除术方法可以安全进行，并发症发生率可接受。与内部对照组相比，并发症发生率相似，但乳房切除皮瓣坏死除外。尽管皮瓣坏死率较高，但 91%的改良 Wise 式乳房切除术患者成功完成了扩张过程。
临床问题/证据水平：治疗性，III 级。
