Wade Ryckie G, Razzano Sergio, Sassoon Elaine M, Haywood Richard M, Ali Rozina S, Figus Andrea
Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital, Norwich, UK.
Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, UK.
Ann Surg Oncol. 2017 Jun;24(6):1465-1474. doi: 10.1245/s10434-017-5807-5. Epub 2017 Feb 22.
The demand for bilateral breast reconstructions is rising worldwide. In the UK, approximately 30% of breast cancer patients undergoing mastectomy choose autologous tissue breast reconstruction. Although the deep inferior epigastric perforator (DIEP) flap is gaining popularity, bilateral DIEP flap breast reconstruction remains a complex procedure and reliable outcome data are lacking. In the absence of clinical trials, evidence from cohort studies is needed to better inform clinicians and patients.
Over a 6-year period, all consecutive patients undergoing DIEP flap breast reconstruction were prospectively included and categorized as unilateral or bilateral reconstruction for comparative analyses of outcomes and complications, with the patient as the unit of analysis.
Overall, 565 DIEP flaps were performed on 468 women (371 unilateral and 97 bilateral reconstructions [194 flaps]). Postoperative complications requiring reoperation were twice as likely for bilateral reconstructions (risk ratio [RR] 2.1, 95% CI 1.4-3.4, p = 0.002) and were mainly due to venous congestion (RR 3.1, 95% CI 1.2-7.5, p = 0.011). The risk of total flap loss was six times greater in bilateral reconstruction (RR 6.4, 95% CI 1.6-26, p = 0.011). The rates of revision breast and abdominal surgery were similar between groups.
Both unilateral and bilateral DIEP flap breast reconstructions are safe, with a low risk of complications; however, bilateral reconstruction was associated with a higher risk of complications and total flap loss. This information should be highlighted to patients requesting bilateral breast reconstruction, particularly those requesting risk-reducing mastectomy and reconstruction.
全球范围内对双侧乳房重建的需求正在上升。在英国，约30%接受乳房切除术的乳腺癌患者选择自体组织乳房重建。尽管腹壁下深动脉穿支（DIEP）皮瓣越来越受欢迎，但双侧DIEP皮瓣乳房重建仍是一个复杂的手术，且缺乏可靠的结果数据。在没有临床试验的情况下，需要队列研究的证据来更好地为临床医生和患者提供信息。
在6年期间，前瞻性纳入所有连续接受DIEP皮瓣乳房重建的患者，并将其分为单侧或双侧重建，以患者为分析单位对结果和并发症进行比较分析。
总体而言，对468名女性进行了565例DIEP皮瓣手术（371例单侧重建和97例双侧重建[194个皮瓣]）。双侧重建术后需要再次手术的并发症发生率是单侧重建的两倍（风险比[RR]2.1，95%置信区间1.4 - 3.4，p = 0.002），主要原因是静脉淤血（RR 3.1，95%置信区间1.2 - 7.5，p = 0.011）。双侧重建中皮瓣完全丢失的风险高6倍（RR 6.4，95%置信区间1.6 - 26，p = 0.011）。两组间乳房和腹部修复手术的发生率相似。
单侧和双侧DIEP皮瓣乳房重建都是安全的，并发症风险低；然而，双侧重建与更高的并发症风险和皮瓣完全丢失风险相关。对于要求双侧乳房重建的患者，尤其是要求进行降低风险乳房切除术和重建的患者，应强调这一信息。
