对于需要进行乳房切除术后放射治疗的女性，是否应考虑立即进行自体乳房重建？一项结果的前瞻性分析。
Should Immediate Autologous Breast Reconstruction Be Considered in Women Who Require Postmastectomy Radiation Therapy? A Prospective Analysis of Outcomes.
作者信息
Billig Jessica, Jagsi Reshma, Qi Ji, Hamill Jennifer B, Kim Hyungjin M, Pusic Andrea L, Buchel Edward, Wilkins Edwin G, Momoh Adeyiza O
机构信息
Ann Arbor, Mich.; New York, N.Y.; and Winnipeg, Manitoba, Canada.
From the Section of Plastic Surgery and the Departments of Radiation Oncology and Biostatistics, University of Michigan; the Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center; and the Section of Plastic Surgery, University of Manitoba.
出版信息
Plast Reconstr Surg. 2017 Jun;139(6):1279-1288. doi: 10.1097/PRS.0000000000003331.
BACKGROUND
In women who require postmastectomy radiation therapy, immediate autologous breast reconstruction is often discouraged. The authors prospectively evaluated postoperative morbidity and satisfaction reported by women undergoing delayed or immediate autologous breast reconstruction in the setting of postmastectomy radiation therapy.
METHODS
Patients enrolled in the Mastectomy Reconstruction Outcomes Consortium study, who received postmastectomy radiotherapy and underwent immediate or delayed free abdominally based autologous breast reconstruction, were identified. Postoperative complications at 1 and 2 years after reconstruction were assessed. Patient-reported outcomes were evaluated using the BREAST-Q questionnaire preoperatively and at 1 and 2 years postoperatively. Bivariate analyses and mixed-effects regression models were used to compare outcomes.
RESULTS
A total of 175 patients met the authors' inclusion criteria. Immediate reconstructions were performed in 108 patients and delayed reconstructions in 67 patients; 93.5 percent of immediate reconstructions were performed at a single center. Overall complication rates were similar based on reconstructive timing (25.9 percent immediate and 26.9 percent delayed at 1 year; p = 0.54). Patients with delayed reconstruction reported significantly lower prereconstruction scores (p < 0.0001) for Satisfaction with Breasts and Psychosocial and Sexual Well-being than did patients with immediate reconstruction. At 1 and 2 years postoperatively, both groups reported comparable levels of satisfaction in assessed BREAST-Q domains.
CONCLUSIONS
From this prospective cohort, immediate autologous breast reconstruction in the setting of postmastectomy radiation therapy appears to be a safe option that may be considered in select patients and centers. Breast aesthetics and quality of life, evaluated from the patient's perspective, were not compromised by flap exposure to radiation therapy.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
背景
对于需要进行乳房切除术后放疗的女性，通常不鼓励立即进行自体乳房重建。作者前瞻性评估了在乳房切除术后放疗情况下接受延迟或立即自体乳房重建的女性报告的术后发病率和满意度。
方法
确定参加乳房切除重建结果联盟研究的患者，这些患者接受了乳房切除术后放疗，并进行了立即或延迟的游离腹壁自体乳房重建。评估重建后1年和2年的术后并发症。术前以及术后1年和2年使用BREAST-Q问卷评估患者报告的结果。使用双变量分析和混合效应回归模型比较结果。
结果
共有175例患者符合作者的纳入标准。108例患者进行了立即重建，67例患者进行了延迟重建；93.5%的立即重建在单一中心进行。基于重建时间的总体并发症发生率相似（1年时立即重建为25.9%，延迟重建为26.9%；p = 0.54）。与立即重建的患者相比，延迟重建的患者在乳房满意度、心理社会和性健康方面的重建前得分显著更低（p < 0.0001）。在术后1年和2年，两组在评估的BREAST-Q领域报告的满意度水平相当。
结论
从这个前瞻性队列研究来看，在乳房切除术后放疗情况下立即进行自体乳房重建似乎是一种安全的选择，在特定患者和中心可以考虑。从患者角度评估，皮瓣接受放疗并未损害乳房美观和生活质量。
临床问题/证据水平：治疗性，III级。
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