Jafferbhoy Sadaf, Chandarana Mihir, Houlihan Maria, Parmeshwar Rishikesh, Narayanan Sankaran, Soumian Soni, Harries Simon, Jones Lucie, Clarke Dayalan
Department of Breast Surgery, University Hospital of North Midlands, Stoke-on-Trent, UK.
Department of Breast Surgery, Royal Lancaster Infirmary, Lancashire, UK.
Gland Surg. 2017 Dec;6(6):682-688. doi: 10.21037/gs.2017.07.07.
BACKGROUND: The last two decades have seen significant changes in surgical management of breast cancer. The offer of immediate breast reconstruction (IBR) following mastectomy is currently standard practice. Skin sparing and nipple sparing mastectomy with implant-based IBR have emerged as oncologically safe treatment options. Prepectoral implant placement and complete coverage of implant with acellular dermal matrix (ADM) eliminates the need to detach the muscle from underlying chest wall in contrast to the subpectoral technique. We report short-term outcomes of a multicentre study from the United Kingdom (UK) using Braxon in women having an IBR. METHODS: A prospective study was conducted from December 2015 to October 2016 and included all patients from three breast units in the UK who underwent a mastectomy and an implant-based IBR using Braxon. The demographic details, co-morbidities, operative details, immediate and delayed complications were recorded. Specific complications recorded were infection, seroma, unplanned readmission and loss of implant. A comparison was made with complications reported in the National Mastectomy and Reconstruction Audit. RESULTS: Seventy-eight IBRs were included in the analysis with a median follow-up of 9.98 months. Mean age of the cohort was 50 years with a mean body mass index of 25.7 kg/m. Mean implant volume was 365 cc. The inpatient hospital stay was 1.48 days. About 23% of patients had a seroma, 30% had erythema requiring antibiotics and the explant rate was 10.2 percent. Bilateral reconstructions were significantly associated with implant loss and peri-operative complications on univariate analysis. CONCLUSIONS: Our early experience with this novel prepectoral technique using Braxon has shown it to be an effective technique with complication rates comparable to subpectoral IBR. The advantages of prepectoral implant-based IBR are quicker postoperative recovery and short post-operative hospital stay. Long-term studies are required to assess rippling, post-operative animation, capsular contracture and impact of radiotherapy.
背景：在过去二十年中，乳腺癌的外科治疗发生了重大变化。乳房切除术后立即进行乳房重建（IBR）目前已成为标准做法。保留皮肤和乳头的乳房切除术联合基于植入物的IBR已成为肿瘤学上安全的治疗选择。与胸肌下技术相比，胸肌前植入物放置以及使用脱细胞真皮基质（ADM）完全覆盖植入物消除了将肌肉从胸壁下层分离的需要。我们报告了英国一项多中心研究中使用Braxon对进行IBR的女性的短期结果。 方法：2015年12月至2016年10月进行了一项前瞻性研究，纳入了英国三个乳腺科所有接受乳房切除术并使用Braxon进行基于植入物的IBR的患者。记录人口统计学细节、合并症、手术细节、即刻和延迟并发症。记录的特定并发症包括感染、血清肿、计划外再入院和植入物丢失。与国家乳房切除术和重建审计报告的并发症进行了比较。 结果：78例IBR纳入分析，中位随访时间为9.98个月。队列的平均年龄为50岁，平均体重指数为25.7kg/m。平均植入物体积为365cc。住院时间为1.48天。约23%的患者出现血清肿，30%出现需要使用抗生素的红斑，取出植入物的比例为10.2%。单因素分析显示双侧重建与植入物丢失和围手术期并发症显著相关。 结论：我们使用Braxon的这种新型胸肌前技术的早期经验表明，它是一种有效的技术，并发症发生率与胸肌下IBR相当。基于胸肌前植入物的IBR的优点是术后恢复更快和术后住院时间短。需要进行长期研究来评估波纹、术后活动、包膜挛缩以及放疗的影响。
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