From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco.
Plast Reconstr Surg. 2019 Jan;143(1):10-20. doi: 10.1097/PRS.0000000000005140.
Prepectoral breast reconstruction following mastectomy has become a more widely performed technique in recent years because of its numerous benefits for women. These include full pectoralis muscle preservation, reduced loss of strength, reduced pain, and elimination of animation deformity. As with any breast reconstruction technique, widespread adoption is dependent on a low morbidity profile in the setting of postmastectomy radiation therapy, as this adjuvant therapy is routine in breast cancer treatment. The authors assess the clinical outcomes of patients undergoing postmastectomy radiation therapy following prepectoral breast reconstruction, and compare these to outcomes of patients undergoing postmastectomy radiation therapy with submuscular reconstruction.
A single surgeon's experience with immediate prepectoral breast reconstruction, followed by postmastectomy radiation therapy, from 2015 to 2017 was reviewed. Patient demographics and incidence of complications during the tissue expander stage were assessed. In addition, the morbidity profile of these patients was compared to that of patients undergoing submuscular/dual-plane reconstruction and postmastectomy radiation therapy over the same period.
Over 3 years, 175 breasts underwent immediate prepectoral reconstruction, and 236 breasts underwent immediate submuscular/dual-plane reconstruction. Overall rates of adjuvant radiation therapy (postmastectomy radiation therapy) were similar between prepectoral [26 breasts (14.9 percent)] and submuscular [31 breasts (13.1 percent)] (p = 0.6180) reconstruction. There were no significant differences in complication rates between the two reconstructive cohorts, in the setting of postmastectomy radiation therapy, including rates of explantation (15.4 percent versus 19.3 percent; p = 0.695).
Prepectoral breast reconstruction is a safe and effective option in the setting of postmastectomy radiation therapy. The morbidity profile is similar to that encountered with submuscular reconstruction in this setting.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
由于其对女性的诸多益处，前胸部乳房重建术已成为近年来更为广泛应用的技术。这些益处包括完整的胸大肌保留、降低力量丧失、减轻疼痛和消除动态畸形。与任何乳房重建技术一样，广泛采用该技术的前提是在前胸部乳房重建后接受乳房切除术放疗的患者中具有较低的发病率，因为这种辅助治疗是乳腺癌治疗的常规治疗方法。作者评估了前胸部乳房重建术后接受乳房切除术放疗的患者的临床结果，并将这些结果与接受乳房切除术放疗和胸肌下重建的患者的结果进行比较。
回顾了一位外科医生在 2015 年至 2017 年间对即刻前胸部乳房重建后接受乳房切除术放疗的经验。评估了患者的人口统计学特征和扩张器阶段并发症的发生率。此外，还比较了这些患者与同期接受胸肌下/双平面重建和乳房切除术放疗的患者的发病率。
在 3 年期间，175 个乳房接受了即刻前胸部重建，236 个乳房接受了即刻胸肌下/双平面重建。前胸部[26 个乳房（14.9%）]和胸肌下[31 个乳房（13.1%）]重建的辅助放疗（乳房切除术放疗）的总体率相似（p = 0.6180）。在接受乳房切除术放疗的情况下，两组重建患者的并发症发生率没有显着差异，包括取出率（15.4%比 19.3%；p = 0.695）。
前胸部乳房重建术是乳房切除术放疗中的一种安全有效的选择。在这种情况下，其发病率与胸肌下重建相似。
临床问题/证据水平：治疗性，III 级。
