保乳术后放疗对胸肌前与胸肌后假体植入式乳房重建的影响。
Impact of Postmastectomy Radiation Therapy in Prepectoral Versus Subpectoral Implant-Based Breast Reconstruction.
机构信息
Long Island Plastic Surgical Group, Garden City, USA.
Yale New Haven Health, New Haven, USA.
出版信息
Ann Surg Oncol. 2018 Oct;25(10):2899-2908. doi: 10.1245/s10434-018-6602-7. Epub 2018 Jul 5.
BACKGROUND
This study aimed to compare the impact of postmastectomy radiation therapy (PMRT) on outcomes after prepectoral versus subpectoral implant-based breast reconstruction with local deepithelialized dermal flap and acellular dermal matrix (ADM).
METHODS
From 2010 to 2017, 274 patients (426 breasts) underwent prepectoral reconstruction. In this group, 241 patients (370 breasts) were not exposed to PMRT, whereas 45 patients (56 breasts) were exposed to PMRT. Of 100 patients (163 breasts) who underwent partial subpectoral reconstruction, 87 (140 breasts) were not exposed to PMRT, whereas 21 patients (23 breasts) were exposed. The outcomes were assessed by comparing complication rates between the pre- and subpectoral groups.
RESULTS
A higher rate of capsular contracture was found for the prepectoral patients with PMRT than for those without PMRT (16.1 vs 3.5%; p = 0.0008) and for the subpectoral patients with PMRT than for those without PMRT (52.2 vs 2.9%; p = 0.0001). The contracture rate was three times higher for the subpectoral patients with PMRT than for the prepectoral patients with PMRT (52.2 vs 16.1%; p = 0.0018). In addition, 10 (83.3%) of 12 cases with capsular contracture in the subpectoral cohort that received PMRT were Baker grades 3 or 4 compared with only 2 (22.2%) of 9 cases of the prepectoral group with PMRT (p = 0.0092).
CONCLUSIONS
The patients undergoing subpectoral breast reconstruction who received PMRT had a capsular contracture rate three times greater with more severe contractures (Baker grade 3 or 4) than the patients receiving PMRT who underwent prepectoral breast reconstruction.
背景
本研究旨在比较胸肌下与胸肌前入路假体乳房重建中，接受与不接受术后放疗（PMRT）对局部去上皮真皮瓣和脱细胞真皮基质（ADM）的影响。
方法
2010 年至 2017 年，274 例（426 侧）患者接受了胸肌前入路重建。在这一组中，241 例（370 侧）患者未接受 PMRT，而 45 例（56 侧）患者接受了 PMRT。在 100 例（163 侧）接受部分胸肌下入路重建的患者中，87 例（140 侧）未接受 PMRT，而 21 例（23 侧）患者接受了 PMRT。通过比较胸肌前和胸肌下两组的并发症发生率来评估结果。
结果
与未接受 PMRT 的患者相比，接受 PMRT 的胸肌前入路患者的包膜挛缩发生率更高（16.1%比 3.5%；p=0.0008），与未接受 PMRT 的患者相比，接受 PMRT 的胸肌下入路患者的包膜挛缩发生率更高（52.2%比 2.9%；p=0.0001）。接受 PMRT 的胸肌下入路患者的挛缩发生率是接受 PMRT 的胸肌前入路患者的三倍（52.2%比 16.1%；p=0.0018）。此外，在接受 PMRT 的胸肌下入路队列中，有 12 例（83.3%）包膜挛缩为 Baker 3 或 4 级，而在接受 PMRT 的胸肌前入路队列中，仅有 9 例（22.2%）为 Baker 3 或 4 级（p=0.0092）。
结论
接受 PMRT 的胸肌下乳房重建患者的包膜挛缩发生率是接受 PMRT 的胸肌前乳房重建患者的三倍，且更严重（Baker 3 或 4 级）。
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