Sue Gloria R, Lee Gordon K
From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford Health Care, Stanford, CA.
Ann Plast Surg. 2018 May;80(5S Suppl 5):S285-S287. doi: 10.1097/SAP.0000000000001379.
Mastectomy skin necrosis is a significant problem after breast reconstruction. We sought to perform a comparative analysis on this complication between patients undergoing autologous breast reconstruction and patients undergoing 2-stage expander implant breast reconstruction.
A retrospective review was performed on consecutive patients undergoing autologous breast reconstruction or 2-stage expander implant breast reconstruction by the senior author from 2006 through 2015. Patient demographic factors including age, body mass index, history of diabetes, history of smoking, and history of radiation to the breast were collected. Our primary outcome measure was mastectomy skin necrosis. Fisher exact test was used for statistical analysis between the 2 patient cohorts. The treatment patterns of mastectomy skin necrosis were then analyzed.
We identified 204 patients who underwent autologous breast reconstruction and 293 patients who underwent 2-stage expander implant breast reconstruction. Patients undergoing autologous breast reconstruction were older, heavier, more likely to have diabetes, and more likely to have had prior radiation to the breast compared with patients undergoing implant-based reconstruction. The incidence of mastectomy skin necrosis was 30.4% of patients in the autologous group compared with only 10.6% of patients in the tissue expander group (P < 0.001). The treatment of this complication differed between these 2 patient groups. In general, those with autologous reconstructions were treated with more conservative means. Although 37.1% of patients were treated successfully with local wound care in the autologous group, only 3.2% were treated with local wound care in the tissue expander group (P < 0.001). Less than half (29.0%) of patients in the autologous group were treated with an operative intervention for this complication compared with 41.9% in the implant-based group (P = 0.25).
Mastectomy skin necrosis is significantly more likely to occur after autologous breast reconstruction compared with 2-stage expander implant-based breast reconstruction. Patients with autologous reconstructions are more readily treated with local wound care compared with patients with tissue expanders, who tended to require operative treatment of this complication. Patients considering breast reconstruction should be counseled appropriately regarding the differences in incidence and management of mastectomy skin necrosis between the reconstructive options.
乳房切除术后皮肤坏死是乳房重建术后的一个重要问题。我们试图对自体乳房重建患者和二期扩张器植入式乳房重建患者的这一并发症进行对比分析。
对2006年至2015年由资深作者连续进行自体乳房重建或二期扩张器植入式乳房重建的患者进行回顾性研究。收集患者的人口统计学因素，包括年龄、体重指数、糖尿病史、吸烟史和乳房放疗史。我们的主要观察指标是乳房切除术后皮肤坏死。对两组患者进行Fisher精确检验以进行统计学分析。然后分析乳房切除术后皮肤坏死的治疗模式。
我们确定了204例行自体乳房重建的患者和293例行二期扩张器植入式乳房重建的患者。与接受植入式重建的患者相比，接受自体乳房重建的患者年龄更大、体重更重、患糖尿病的可能性更大，且更有可能曾接受过乳房放疗。自体组乳房切除术后皮肤坏死的发生率为30.4%，而组织扩张器组仅为10.6%（P<0.001）。这两组患者对该并发症的治疗方法不同。总体而言，自体重建患者采用更保守的治疗方法。虽然自体组37.1%的患者通过局部伤口护理成功治愈，但组织扩张器组只有3.2%的患者采用局部伤口护理（P<0.001）。自体组不到一半（29.0%）的患者因该并发症接受了手术干预，而植入式组为41.9%（P=0.25）。
与二期扩张器植入式乳房重建相比，自体乳房重建后乳房切除术后皮肤坏死的发生可能性显著更高。与组织扩张器患者相比，自体重建患者更容易通过局部伤口护理进行治疗，而组织扩张器患者往往需要对该并发症进行手术治疗。应就乳房重建选择之间乳房切除术后皮肤坏死的发生率和处理差异，对考虑乳房重建的患者进行适当的咨询。
