Huis in 't Veld Eva A, Long Chao, Sue Gloria R, Chattopadhyay Arhana, Lee Gordon K
From the Department of Plastic and Reconstructive Surgery, Stanford University Medical Center, Stanford, CA.
Ann Plast Surg. 2018 May;80(5S Suppl 5):S303-S307. doi: 10.1097/SAP.0000000000001418.
Patients with breast cancer frequently opt to undergo breast reconstruction after mastectomy. The timing and aesthetic outcome of the breast reconstruction may be affected by the need for radiation therapy (RT). Delayed-immediate autologous reconstruction (DIAR) is a novel surgical approach for patients in whom the need for adjuvant RT after mastectomy is preoperatively unknown.
We sought to evaluate the difference in clinical outcomes, patient satisfaction, and cosmetic results between DIAR and patients who underwent delayed autologous reconstruction.
A total of 19 DIAR and 19 delayed patients were retrospectively included.Patient demographics, surgical characteristics, and complications were obtained from patient files. Patients scored their satisfaction using the breast-Q questionnaire, and independent reviewers scored cosmetic outcomes, including skin quality/color, scar formation, symmetry, breast contour/size/position, and overall aesthetic outcome. The DIAR patients were matched to delayed patients based on age, body mass index, and unilateral or bilateral reconstruction.
The median age in the delayed group was 48 years (range, 31-61 years) and 46 years (range, 29-64 years) in the DIAR group, with a median body mass index of 28.8 (range, 21.4-40.5) and 28.6 (range, 24-1.9), respectively.There were no significant differences in demographics between the two groups. In total, 16 patients underwent unilateral reconstruction and 22 patients bilateral reconstruction. Delayed-immediate autologous reconstruction was associated with a higher infection rate compared with delayed reconstruction, 8 and 1, respectively (P = 0.026). All infections in the DIAR group were tissue expander-related. The DIAR patients had significantly better breast contour/size/position and overall aesthetics compared with the delayed reconstruction group (P = 0.001). In addition, patients who did not receive RT had significant better cosmetic outcome (P < 0.001). There were no significant differences in patient satisfaction between the DIAR and delayed group.
Delayed-immediate autologous reconstruction should be considered as an option for patients wanting autologous reconstruction when the need for RT remains unknown. Delayed-immediate autologous reconstruction demonstrates better breast contour/size/position and overall aesthetic outcome.
乳腺癌患者在乳房切除术后常选择进行乳房重建。乳房重建的时机和美学效果可能会受到放疗（RT）需求的影响。延迟即刻自体重建（DIAR）是一种针对乳房切除术后辅助放疗需求术前未知患者的新型手术方法。
我们试图评估DIAR与接受延迟自体重建患者在临床结局、患者满意度和美容效果方面的差异。
回顾性纳入19例DIAR患者和19例延迟重建患者。从患者病历中获取患者人口统计学资料、手术特征和并发症情况。患者使用乳房Q问卷对其满意度进行评分，独立评审员对美容效果进行评分，包括皮肤质量/颜色、瘢痕形成、对称性、乳房轮廓/大小/位置以及整体美学效果。根据年龄、体重指数以及单侧或双侧重建情况，将DIAR患者与延迟重建患者进行匹配。
延迟重建组的中位年龄为48岁（范围31 - 61岁），DIAR组为46岁（范围29 - 64岁），中位体重指数分别为28.8（范围21.4 - 40.5）和28.6（范围24 - 1.9）。两组在人口统计学方面无显著差异。共有16例患者进行了单侧重建，22例患者进行了双侧重建。与延迟重建相比，延迟即刻自体重建的感染率更高，分别为8例和1例（P = 0.026）。DIAR组所有感染均与组织扩张器相关。与延迟重建组相比，DIAR患者的乳房轮廓/大小/位置及整体美学效果显著更好（P = 0.001）。此外，未接受放疗的患者美容效果显著更好（P < 0.001）。DIAR组与延迟重建组在患者满意度方面无显著差异。
当放疗需求未知时，延迟即刻自体重建应被视为想要进行自体重建患者的一种选择。延迟即刻自体重建显示出更好的乳房轮廓/大小/位置及整体美学效果。
