Zhao Ruya, Tran Bao Ngoc N, Doval Andres F, Broadwater Gloria, Buretta Kate J, Orr Jonah P, Lee Bernard T, Hollenbeck Scott T
Duke University School of Medicine, Durham, North Carolina.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
J Reconstr Microsurg. 2018 Nov;34(9):685-691. doi: 10.1055/s-0038-1641680. Epub 2018 May 7.
Breast implant placement is the most common method for postmastectomy reconstruction. For patients who develop complications associated with implant-based reconstruction, additional surgeries may be challenging. This study examined implant-based reconstruction failure in patients undergoing salvage with abdominal free tissue transfer.
We conducted an Institutional Review Board approved, multicenter retrospective study of patients with implant-based primary breast reconstruction followed by implant removal and subsequent abdominal free tissue transfer between 2006 and 2016. Patient demographics, treatment details, and complications were evaluated. Severity of implant failure was graded as either (1) not severe (delayed salvage reconstruction) or (2) severe (immediate salvage reconstruction).
Between 2006 and 2016, 115 patients with 180 mastectomy defects underwent primary implant-based reconstruction with subsequent implant removal and abdominally based free tissue reconstruction. Of these, 68 were delayed and 47 were immediate salvage reconstruction. Factors leading to elective removal were capsular contracture, asymmetry, and implant malposition. Factors leading to obligatory removal were infection, delayed wound healing, and implant extrusion. Postmastectomy radiation was significantly associated with immediate salvage reconstruction ( < 0.001, odds ratio = 3.9) as were large volume implants ( = 0.06). Deep inferior epigastric perforator flaps comprised 78.3% of all abdominally based free tissue reconstructions, while muscle-sparing transverse rectus abdominus myocutaneous flaps comprised 18.3%. Overall flap failure rate was 2.6% (2.94% delayed and 2.13% immediate salvage reconstruction; = 1.0).
Our findings suggest that abdominal free tissue transfer remains a safe and effective salvage modality for implant-based breast reconstruction failure. Patients with severe implant failure were more likely to have received radiation. Surgeons should remain cognizant of this during care of patients.
乳房植入物置入是乳房切除术后重建最常用的方法。对于发生与植入物重建相关并发症的患者，额外的手术可能具有挑战性。本研究调查了接受腹部游离组织移植挽救治疗的患者中基于植入物重建的失败情况。
我们进行了一项经机构审查委员会批准的多中心回顾性研究，研究对象为2006年至2016年间接受基于植入物的一期乳房重建、随后取出植入物并进行腹部游离组织移植的患者。评估了患者的人口统计学特征、治疗细节和并发症。植入物失败的严重程度分为（1）不严重（延迟挽救重建）或（2）严重（即刻挽救重建）。
2006年至2016年间，115例有180处乳房切除缺损的患者接受了基于植入物的一期重建，随后取出植入物并进行腹部游离组织重建。其中，68例为延迟挽救重建，47例为即刻挽救重建。导致择期取出植入物的因素包括包膜挛缩、不对称和植入物位置不当。导致必须取出植入物的因素包括感染、伤口愈合延迟和植入物外露。乳房切除术后放疗与即刻挽救重建显著相关（<0.001，比值比=3.9），大容量植入物也是如此（=0.06）。腹壁下深动脉穿支皮瓣占所有腹部游离组织重建的78.3%，而保留肌肉的腹直肌肌皮瓣占18.3%。总体皮瓣失败率为2.6%（延迟挽救重建为2.94%，即刻挽救重建为2.13%；=1.0）。
我们的研究结果表明，腹部游离组织移植仍然是基于植入物的乳房重建失败的一种安全有效的挽救方式。严重植入物失败的患者更有可能接受过放疗。外科医生在治疗患者时应牢记这一点。
