Sue Gloria R, Sun Beatrice J, 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):S292-S294. doi: 10.1097/SAP.0000000000001382.
Two-stage expander implant breast reconstruction is commonly performed after mastectomy. Salvage and long-term outcomes after development of complications have not been well described. We examined a single surgeon's experience to study the rate of reoperation secondary to complications after first-stage expander placement and to evaluate their outcomes. Better understanding of salvage techniques may help guide future management.
We performed a retrospective analysis of consecutive patients who underwent placement of a tissue expander (TE) for breast reconstruction between December 2006 and August 2015 with the senior author. Patient demographics including age, body mass index, medical comorbidities, history of smoking, and history of radiation to the breast were collected. Surgical factors including timing of reconstruction (immediate vs delayed) and location of TE (total submuscular vs with acellular dermal matrix) were recorded. Complications were analyzed, as were patients who underwent reoperation in the setting of developing a complication.
We analyzed 282 patients who underwent 453 implant-based breast reconstructions. Of these, 39 patients and 45 breasts required a reoperation after development of a postoperative complication. Return to the operating room was associated with higher body mass index (29 vs 24, P < 0.001), higher TE initial fill volume (299 mL vs 169 mL, P < 0.001), and preoperative radiation (31% vs 13%, P = 0.001). Complications resulting in reoperation included infection (60%), mastectomy skin necrosis (27%), and TE extrusion through thin mastectomy skin (11%). The affected TE was removed and exchanged in 17 patients (38%), autologous flap reconstruction occurred in 16 patients (36%), and TE was explanted without replacement in 12 patients (27%).
Infectious complications including cellulitis and abscess formation accounted for most cases requiring reoperation after TE placement for breast reconstruction. More than a quarter of patients who underwent a reoperation ultimately lost their implants. Patients undergoing two-stage expander implant breast reconstruction should be appropriately counseled regarding the possibility of requiring a reoperation in the setting of developing a complication.
乳房切除术后常采用两阶段扩张器植入乳房重建术。并发症出现后的挽救措施及长期效果尚未得到充分描述。我们研究了一位外科医生的经验，以探讨一期扩张器置入术后因并发症而再次手术的发生率，并评估其结果。更好地了解挽救技术可能有助于指导未来的治疗。
我们对2006年12月至2015年8月间由资深作者进行组织扩张器（TE）置入乳房重建的连续患者进行了回顾性分析。收集患者的人口统计学资料，包括年龄、体重指数、内科合并症、吸烟史和乳房放疗史。记录手术因素，包括重建时机（即刻与延迟）和TE的位置（全肌下与使用脱细胞真皮基质）。分析并发症情况，以及在出现并发症时接受再次手术的患者情况。
我们分析了282例行453次基于植入物的乳房重建的患者。其中，39例患者和45个乳房在术后出现并发症后需要再次手术。返回手术室与较高的体重指数（29 vs 24，P < 0.001）、较高的TE初始填充量（299 mL vs 169 mL，P < 0.001）和术前放疗（31% vs 13%，P = 0.001）相关。导致再次手术的并发症包括感染（60%）、乳房切除皮肤坏死（27%）和TE通过薄的乳房切除皮肤挤出（11%）。17例患者（38%）取出并更换了受影响的TE，16例患者（36%）进行了自体皮瓣重建，12例患者（27%）取出TE后未进行更换。
包括蜂窝织炎和脓肿形成在内的感染性并发症是TE置入乳房重建术后需要再次手术的大多数病例的原因。超过四分之一接受再次手术的患者最终失去了植入物。对于接受两阶段扩张器植入乳房重建的患者，应就出现并发症时可能需要再次手术的情况给予适当的咨询。
