McFadden Eoin M, Lopez-Obregon Beatriz, Stone Jill P, Webb Carmen E, Temple-Oberle Claire F
Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan.
Departments of Surgery and Oncology, University of Calgary, Calgary Alberta.
Plast Reconstr Surg Glob Open. 2018 Dec 17;6(12):e2027. doi: 10.1097/GOX.0000000000002027. eCollection 2018 Dec.
Traditional transverse mastectomies yield suboptimal results in women with higher body mass index, wide breast footprint, and ptotic breasts. An option for this patient population is a reduction-pattern style mastectomy, and recruiting an inferiorly based dermal flap using the lower mastectomy flap. This is analogous to a vascularized dermal matrix supporting the lower pole of the implant, termed "Autoderm" breast reconstruction. This allows for aesthetically appealing skin reduction mastectomies with the added safety of a vascularized dermal flap to facilitate an immediate direct-to-implant breast reconstruction. This study assesses patient satisfaction using the validated BRECON-31 questionnaire to enhance shared-decision making with women contemplating breast reconstruction.
A 2-year retrospective review of women who underwent Autoderm direct-to-implant breast reconstruction comparing patients who underwent unilateral and bilateral reconstruction in terms of characteristics, complications, and BRECON-31 scoring.
Overall patient scores were high (81.6 of 100). In particular, women scored very high on self-image (85.0), arm concerns (86.4), intimacy (87.4), satisfaction (88.3), and expectations subscales (85.5). Women choosing bilateral reconstruction outperformed unilateral reconstruction in every subgroup, but only attained statistical significance in the "self-consciousness" subgroup. Compared with a historical cohort of a mix of implant reconstruction types, Autoderm patients showed improved satisfaction (88.3 versus 82.5; = 0.07) and breast appearance (73.9 versus 66.8; = 0.06), approaching significance. Safety was demonstrated by low major complications (4.7%) and low implant loss rates (2.3%).
Autoderm breast reconstruction is a safe option in women with large, ptotic breasts, with patients reporting high satisfaction using a validated instrument.
传统的横向乳房切除术在体重指数较高、乳房基底较宽以及乳房下垂的女性中效果欠佳。对于这类患者群体，一种选择是采用缩乳式乳房切除术，并利用乳房下皱襞皮瓣构建一个以下方为蒂的真皮瓣。这类似于一个为植入物下极提供支撑的带血管化真皮基质，即“自体真皮”乳房重建术。这使得在进行具有美学吸引力的皮肤缩减乳房切除术的同时，增加了带血管化真皮瓣的安全性，便于即刻进行直接植入式乳房重建。本研究使用经过验证的BRECON - 31问卷评估患者满意度，以加强与考虑进行乳房重建的女性的共同决策。
对接受自体真皮直接植入式乳房重建的女性进行为期2年的回顾性研究，比较单侧和双侧重建患者在特征、并发症及BRECON - 31评分方面的情况。
患者总体评分较高（满分100分，平均81.6分）。特别是，女性在自我形象（85.0分）、手臂相关问题（86.4分）、亲密感（87.4分）、满意度（88.3分）和期望子量表（85.5分）上得分很高。选择双侧重建的女性在每个亚组中的表现均优于单侧重建，但仅在“自我意识”亚组中达到统计学显著性。与一组历史上不同类型植入物重建的队列相比，自体真皮患者的满意度有所提高（88.3分对82.5分；P = 0.07），乳房外观也有所改善（73.9分对66.8分；P = 0.06），接近显著性水平。低严重并发症发生率（4.7%）和低植入物丢失率（2.3%）证明了该手术的安全性。
自体真皮乳房重建术对于乳房大且下垂的女性是一种安全的选择，患者使用经过验证的工具报告满意度较高。
