Division of Plastic and Reconstructive Surgery, Duke University Medical Center, Durham, North Carolina.
Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina.
J Reconstr Microsurg. 2019 Jul;35(6):417-424. doi: 10.1055/s-0038-1677037. Epub 2019 Jan 7.
Despite limited oncologic benefit for women without an increased risk for breast cancer, the rates of contralateral prophylactic mastectomy (CPM) have increased. Patients undergoing CPM are more likely to undergo bilateral and immediate breast reconstruction. This study assessed the relationship between the timing and laterality of free flap-based breast reconstruction and the risk of postoperative bleeding complications.
Women undergoing postmastectomy free-flap based breast reconstruction from 2010 to 2015 were identified using the National Surgical Quality Improvement Program (NSQIP) dataset. Patients were categorized according to reconstructive laterality and timing. Modified Poisson regression was used to assess the risk of postoperative bleeding and complications across reconstructive procedures.
Of the 4,133 patients undergoing free flap-based breast reconstruction, 12% ( = 494) experienced postoperative bleeding complications. Bilateral immediate reconstruction was associated with the highest incidence of bleeding (16.6%, = 188), followed by bilateral delayed (12.8%, = 58), unilateral immediate (10%, = 142), and unilateral delayed reconstruction (9.4%, = 106). Among patients undergoing immediate reconstruction, bilateral, rather than unilateral, reconstruction was associated with a significantly elevated risk of bleeding complications (RR [rate ratio] = 1.58; 95% CI [confidence interval] =1.19, 2.10; = 0.0002). Furthermore, immediate bilateral reconstruction was associated with a significantly higher rate of return to the operating room (RR =1.39; 95% CI =1.06, 1.82; adjusted = 0.009) when compared with a unilateral procedure.
Patients undergoing immediate bilateral free flap-based breast reconstruction may be at an increased risk for experiencing acute postoperative bleeding complications and a return to the operating room. Patients undergoing CPM and considering immediate reconstruction should be counseled regarding the increased morbidity of a bilateral reconstructive procedure.
尽管对于没有乳腺癌风险增加的女性来说，接受对侧预防性乳房切除术（CPM）的获益有限，但 CPM 的比率仍在增加。接受 CPM 的患者更有可能接受双侧即刻乳房重建。本研究评估了游离皮瓣乳房重建的时机和部位与术后出血并发症风险之间的关系。
利用国家外科质量改进计划（NSQIP）数据库，确定了 2010 年至 2015 年期间接受乳房切除术后游离皮瓣重建的女性患者。根据重建的部位和时机对患者进行分类。采用修正泊松回归评估各种重建手术的术后出血和并发症风险。
在接受游离皮瓣乳房重建的 4133 例患者中，有 12%（494 例）发生了术后出血并发症。双侧即刻重建的出血发生率最高（16.6%，188 例），其次是双侧延迟重建（12.8%，58 例）、单侧即刻重建（10%，142 例）和单侧延迟重建（9.4%，106 例）。在接受即刻重建的患者中，与单侧重建相比，双侧重建与出血并发症风险显著升高相关（RR[率比]1.58；95%CI[置信区间]1.19,2.10；=0.0002）。此外，与单侧手术相比，即刻双侧重建与更高的再次手术率相关（RR=1.39；95%CI=1.06,1.82；调整后=0.009）。
接受即刻双侧游离皮瓣乳房重建的患者可能有更高的发生急性术后出血并发症和再次手术的风险。接受 CPM 并考虑即刻重建的患者应告知他们接受双侧重建手术的发病率增加。
