1000余例保留乳头的乳房切除术中组织扩张器、即刻植入物和自体乳房重建的结局比较
Comparison of Outcomes with Tissue Expander, Immediate Implant, and Autologous Breast Reconstruction in Greater Than 1000 Nipple-Sparing Mastectomies.
作者信息
Frey Jordan D, Choi Mihye, Salibian Ara A, Karp Nolan S
机构信息
New York, N.Y.
From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center.
出版信息
Plast Reconstr Surg. 2017 Jun;139(6):1300-1310. doi: 10.1097/PRS.0000000000003340.
BACKGROUND
Nipple-sparing mastectomy permits complete preservation of the nipple-areola complex with excellent aesthetic results and with oncologic safety similar to that associated with traditional mastectomy techniques. However, outcomes have not been directly compared for tissue expander-, immediate implant-, and autologous tissue-based breast reconstruction after nipple-sparing mastectomy.
METHODS
All patients undergoing nipple-sparing mastectomy from 2006 to June of 2016 were identified at a single institution. Demographics and outcomes were analyzed and compared among different types of breast reconstruction.
RESULTS
A total of 1028 nipple-sparing mastectomies were performed. Of these, 533 (51.8 percent) were tissue expander-based, 263 (25.6 percent) were autologous tissue-based, and 232 (22.6 percent) were immediate implant-based reconstructions. Tissue expander-based reconstructions had significantly more minor cellulitis (p = 0.0002) but less complete nipple necrosis (p = 0.0126) and major mastectomy flap necrosis (p < 0.0001) compared with autologous tissue-based reconstructions. Compared to immediate implant-based reconstruction, tissue expander-based reconstructions had significantly more minor cellulitis (p = 0.0006) but less complete nipple necrosis (p = 0.0005) and major (p < 0.0001) and minor (p = 0.0028) mastectomy flap necrosis (p = 0.0059). Immediate implant-based reconstructions had significantly more minor cellulitis (p = 0.0051), minor mastectomy flap necrosis (p = 0.0425), and partial nipple necrosis (p = 0.0437) compared with autologous tissue-based reconstructions. Outcomes were otherwise equivalent among the three groups.
CONCLUSIONS
Tissue expander, immediate implant, and autologous tissue breast reconstruction techniques may all be safely offered with nipple-sparing mastectomy. However, reconstructive complications appear to be greater with immediate implant- and autologous tissue-based techniques compared with tissue expander-based reconstruction.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
背景
保留乳头的乳房切除术能够完整保留乳头乳晕复合体，美学效果极佳，且肿瘤学安全性与传统乳房切除技术相当。然而，对于保留乳头乳房切除术后采用组织扩张器、即刻植入物和自体组织进行乳房重建的效果，尚未进行直接比较。
方法
确定了在一家机构接受2006年至2016年6月期间保留乳头乳房切除术的所有患者。分析并比较了不同类型乳房重建的人口统计学和结果。
结果
共进行了1028例保留乳头的乳房切除术。其中，533例（51.8%）采用组织扩张器重建，263例（25.6%）采用自体组织重建，232例（22.6%）采用即刻植入物重建。与自体组织重建相比，组织扩张器重建的轻微蜂窝织炎明显更多（p = 0.0002），但完全乳头坏死更少（p = 0.0126），乳房切除皮瓣大面积坏死更少（p < 0.0001）。与即刻植入物重建相比，组织扩张器重建的轻微蜂窝织炎明显更多（p = 0.0006），但完全乳头坏死更少（p = 0.0005），乳房切除皮瓣大面积（p < 0.0001）和小面积（p = 0.0028）坏死更少（p = 0.0059）。与自体组织重建相比，即刻植入物重建的轻微蜂窝织炎明显更多（p = 0.0051）、乳房切除皮瓣小面积坏死更多（p = 0.0425）和部分乳头坏死更多（p = 0.0437）。三组的其他结果相当。
结论
组织扩张器、即刻植入物和自体组织乳房重建技术均可安全地应用于保留乳头的乳房切除术。然而，与组织扩张器重建相比，即刻植入物和自体组织重建技术的重建并发症似乎更多。
临床问题/证据水平：治疗性，III级。
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