Choi Mihye, Frey Jordan D, Alperovich Michael, Levine Jamie P, Karp Nolan S
New York, N.Y.
From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center.
Plast Reconstr Surg. 2016 Aug;138(2):184e-191e. doi: 10.1097/PRS.0000000000002333.
Nipple-sparing mastectomy with immediate, permanent implant reconstruction offers patients a prosthetic "breast in a day" compared to tissue expander techniques requiring multiple procedures.
Patients undergoing nipple-sparing mastectomy with immediate, permanent implant reconstruction were reviewed with patient demographics and outcomes analyzed.
Of 842 nipple-sparing mastectomies from 2006 to June of 2015, 160 (19.0 percent) underwent immediate, permanent implant reconstruction. The average age and body mass index were 46.5 years and 23.3 kg/m. The majority of implants were either Allergan Style 20 (48.1 percent) or Style 15 (22.5 percent). The average implant size was 376.2 ml, and 91.3 percent of reconstructions used acellular dermal matrix. The average number of reconstructive operations was 1.3. Follow-up was 21.9 months. The most common major complication was major mastectomy flap necrosis (8.1 percent). The rate of reconstructive failure was 5.6 percent and implant loss was 4.4 percent. The most common minor complication was minor mastectomy flap necrosis (14.4 percent). The rates of full-thickness and partial-thickness nipple necrosis were 4.4 and 7.5 percent, respectively. Age older than 50 years (p = 0.0276) and implant size greater than 400 ml (p = 0.0467) emerged as independent predictors of overall complications. Obesity (p = 0.4073), tobacco use (p = 0.2749), prior radiation therapy (p = 0.4613), and acellular dermal matrix (p = 0.5305) were not associated with greater complication rates.
Immediate, permanent implant reconstruction in nipple-sparing mastectomy provides patients with a breast in a day in less than two procedures, with a low complication rate.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
与需要多次手术的组织扩张技术相比，保留乳头的乳房切除术并立即进行永久性植入物重建可为患者提供假体“一日乳房”。
对接受保留乳头的乳房切除术并立即进行永久性植入物重建的患者进行回顾，分析患者的人口统计学资料和手术结果。
在2006年至2015年6月期间进行的842例保留乳头的乳房切除术中，160例（19.0%）进行了立即永久性植入物重建。平均年龄和体重指数分别为46.5岁和23.3kg/m²。大多数植入物为Allergan Style 20（48.1%）或Style 15（22.5%）。平均植入物大小为376.2ml，91.3%的重建使用了脱细胞真皮基质。平均重建手术次数为1.3次。随访时间为21.9个月。最常见的主要并发症是乳房切除皮瓣大面积坏死（8.1%）。重建失败率为5.6%，植入物丢失率为4.4%。最常见的次要并发症是乳房切除皮瓣小面积坏死（14.4%）。全层和部分乳头坏死率分别为4.4%和7.5%。年龄大于50岁（p = 0.0276）和植入物大小大于400ml（p = 0.0467）是总体并发症的独立预测因素。肥胖（p = 0.4073）、吸烟（p = 0.2749）、既往放疗（p = 0.4613）和脱细胞真皮基质（p = 0.5305）与较高的并发症发生率无关。
保留乳头的乳房切除术中立即进行永久性植入物重建，可在少于两次手术的情况下为患者提供一日乳房，并发症发生率低。
临床问题/证据级别：治疗性，IV级。
