Kearney Aaron M, Brown Matthew S, Soltanian Hooman T
Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Plastic Surgery, University Hospitals - Case Medical Center, Cleveland, OH, USA.
J Plast Reconstr Aesthet Surg. 2015 Dec;68(12):1719-26. doi: 10.1016/j.bjps.2015.08.034. Epub 2015 Sep 4.
Limited data exist regarding the effect of radiation timing on complications of tissue expander/implant-based breast reconstruction. This study seeks to compare outcomes of tissue expander/implant reconstruction in patients undergoing postmastectomy radiotherapy, those with previous radiation therapy following breast conservation therapy, and those who did not receive radiation therapy.
The records of the patients of a single surgeon were reviewed from January 2007 to July 2013. All patients undergoing tissue expander/implant breast reconstruction were placed into one of three groups based on the timing of radiation therapy: postmastectomy (Current), previously following breast conservation therapy (Prior), and no radiotherapy (No XRT). Medical records were reviewed for any reported complications, and statistical analysis was performed.
A total of 210 patients (265 breasts) were included in the analysis. Current patients were more likely than No XRT patients to experience expander infection (20% vs. 2.6%, p = 0.001) and expander removal (26% vs. 8.3%, p = 0.007). Prior patients were more likely than No XRT patients to undergo conversion to tissue flap reconstruction (10.5% vs. 0.6%, p = 0.031). No significant differences were found between groups with respect to cellulitis, abscess formation, hematoma, seroma, skin flap necrosis, expander exposure, implant exposure, or implant infection.
This study supports the relative safety of tissue expander/implant breast reconstruction in selected groups of patients who have received radiation therapy. Differences in rates of expander infection, expander removal, and conversion to tissue flap reconstruction represent potential areas for further research.
关于放疗时机对组织扩张器/植入物乳房重建并发症的影响，现有数据有限。本研究旨在比较接受乳房切除术后放疗的患者、保乳治疗后曾接受放疗的患者以及未接受放疗的患者在组织扩张器/植入物重建方面的结果。
回顾了2007年1月至2013年7月间一位外科医生的患者记录。所有接受组织扩张器/植入物乳房重建的患者根据放疗时机分为三组：乳房切除术后（当前组）、保乳治疗后曾接受放疗（既往组）和未接受放疗（无放疗组）。查阅病历以了解任何报告的并发症，并进行统计分析。
共有210例患者（265侧乳房）纳入分析。当前组患者比无放疗组患者更易发生扩张器感染（20%对2.6%，p = 0.001）和扩张器取出（26%对8.3%，p = 0.007）。既往组患者比无放疗组患者更易转为组织瓣重建（10.5%对0.6%，p = 0.031）。在蜂窝织炎、脓肿形成、血肿、血清肿、皮瓣坏死、扩张器外露、植入物外露或植入物感染方面，各组之间未发现显著差异。
本研究支持在部分接受过放疗的患者组中进行组织扩张器/植入物乳房重建的相对安全性。扩张器感染率、扩张器取出率以及转为组织瓣重建率的差异是进一步研究的潜在领域。
