Thorarinsson Andri, Fröjd Victoria, Kölby Lars, Lidén Mattias, Elander Anna, Mark Hans
Department of Plastic Surgery, Sahlgrenska University Hospital, Institute for Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Gland Surg. 2017 Aug;6(4):355-367. doi: 10.21037/gs.2017.04.04.
Breast reconstruction is an essential component in the treatment of breast cancer. Postoperative complications after breast reconstruction are common and affect patient satisfaction. Determining independent risk factors using patient characteristics could be advantageous for patient assessment and counseling.
We retrospectively enrolled 623 consecutive patients who underwent reconstruction with a deep inferior epigastric perforator flap (DIEP), latissimus dorsi flap (LD), lateral thoracodorsal flap (LTDF), or tissue expander with a secondary implant (EXP) in this study. Information on demographic and perioperative factors was collected, as well as information on all postoperative complications. Logistic regression was used to analyze associations between possible patient-related risk factors and postoperative complications.
Smoking was associated with the highest number of early overall complications [odds ratio (OR) 2.05, 95% confidence interval (CI) 1.25-3.37, P=0.0005], followed by body mass index (BMI) (OR 1.07, 95% CI 1.01-1.13, P=0.017). High BMI was associated with the highest number of late overall postoperative complications (OR 1.06, 95% CI 1.00-1.11, P=0.042), followed by history of radiotherapy (OR 1.66, 95% CI 1.01-2.74, P=0.046). When the risk factors were combined, the risk for postoperative complications rose exponentially.
Our results provide evidence that patients should cease smoking and overweight patients should lose weight before undergoing breast reconstruction. Additionally, if the patient has received radiotherapy, the reconstruction method should be carefully chosen. High BMI, history of radiotherapy, and smoking are independent risk factors for many types of both early and late postoperative complications in breast reconstructive surgery. Combining these risk factors multiplies the risk of postoperative complications.
乳房重建是乳腺癌治疗的重要组成部分。乳房重建术后并发症很常见，会影响患者满意度。利用患者特征确定独立危险因素可能有助于患者评估和咨询。
本研究回顾性纳入了623例连续接受腹壁下深动脉穿支皮瓣（DIEP）、背阔肌皮瓣（LD）、胸背外侧皮瓣（LTDF）或组织扩张器二期植入（EXP）重建手术的患者。收集了人口统计学和围手术期因素的信息，以及所有术后并发症的信息。采用逻辑回归分析可能的患者相关危险因素与术后并发症之间的关联。
吸烟与早期总体并发症数量最多相关[比值比（OR）2.05，95%置信区间（CI）1.25 - 3.37，P = 0.0005]，其次是体重指数（BMI）（OR 1.07，95% CI 1.01 - 1.13，P = 0.017）。高BMI与晚期总体术后并发症数量最多相关（OR 1.06，95% CI 1.00 - 1.11，P = 0.042），其次是放疗史（OR 1.66，95% CI 1.01 - 2.74，P = 0.046）。当危险因素合并时，术后并发症风险呈指数上升。
我们的结果表明，患者在进行乳房重建前应戒烟，超重患者应减重。此外，如果患者接受过放疗，应谨慎选择重建方法。高BMI、放疗史和吸烟是乳房重建手术中多种早期和晚期术后并发症的独立危险因素。合并这些危险因素会使术后并发症风险成倍增加。
