Thuman Jenna, Freitas Alessandrina M, Schaeffer Christie, Campbell Chris A
From the Department of Plastic Surgery, University of Virginia Health System, Charlottesville, VA.
Ann Plast Surg. 2019 Jun;82(6S Suppl 5):S404-S409. doi: 10.1097/SAP.0000000000001791.
The obese or ptotic breast demonstrates significant difficulty in breast reconstruction after mastectomy with increased rates of perioperative complications compared with the general population, regardless of reconstruction type. Implant-based reconstruction in this patient population with the traditional horizontal elliptical skin-sparing mastectomy tends to have aesthetically displeasing qualities secondary to skin flap redundancy and blunting of the breast contour. Wise-pattern closures have been described with submuscular direct-to-implant and 2-stage reconstructions, with more favorable complication profile when staged. Our study aims to report outcomes and safety of a prepectoral 2-stage wise-pattern closure technique in the obese and/or ptotic population.
A retrospective chart review was performed to identify all overweight, obese, and/or grade III ptotic patients who have undergone a 2-stage, wise-pattern skin closure with prepectoral placement of tissue expander by a single surgeon. Patient demographics, comorbidities, and perioperative descriptors were reported. Delayed wound healing, infection, seroma formation, and explantation or reoperation were recorded for each patient involved in the study.
Thirty-seven obese and/or ptotic breasts among 21 patients underwent immediate prepectoral tissue expander placement with wise-pattern skin reduction closure with mean body mass index of 35.3 kg/m, and 25% of patients were diabetic The most common complication rates by breast were seroma formation (50%) and wound/dehiscence at T-point (28.6%), which all ultimately healed with intervention as described. One major (2.7%) and 1 minor (2.7%) infection were successfully treated with antibiotics. There were no cases of implant exposure. Two operative complex repairs and 1 elective explantation were performed. Diabetes and increasing body mass index were statistically associated with an increased overall perioperative complication rate.
Prepectoral, 2-stage breast reconstruction with wise-pattern skin reduction performs well in obese and/or ptotic patients with favorable rates of perioperative complications. Wound dehiscence was prevalent but managed with wound care when complex repair was not required to expedite adjuvant chemotherapy. Infection rates and reoperation rates were low, and all patients reported positive aesthetic results at the completion of reconstruction.
与普通人群相比，肥胖或下垂的乳房在乳房切除术后进行乳房重建时困难重重，围手术期并发症发生率更高，且与重建类型无关。在这一患者群体中，采用传统的水平椭圆形保乳皮肤切除术进行基于植入物的重建，往往会因皮瓣冗余和乳房轮廓变钝而产生美学上不尽人意的效果。对于肌下直接植入和两阶段重建，已描述了 Wise 模式闭合术，分期进行时并发症情况更有利。我们的研究旨在报告在肥胖和/或下垂人群中采用胸肌前两阶段 Wise 模式闭合技术的结果和安全性。
进行回顾性病历审查，以确定所有接受过由单一外科医生进行的两阶段、Wise 模式皮肤闭合术并在胸肌前放置组织扩张器的超重、肥胖和/或III级下垂患者。报告患者的人口统计学特征、合并症和围手术期描述。记录参与研究的每位患者的伤口愈合延迟、感染、血清肿形成以及取出植入物或再次手术情况。
21例患者中的37个肥胖和/或下垂乳房接受了即刻胸肌前组织扩张器置入及 Wise 模式皮肤缩减闭合术，平均体重指数为35.3kg/m²，25%的患者患有糖尿病。按乳房计算，最常见的并发症发生率为血清肿形成（50%）和T点伤口裂开（28.6%），经所述干预后最终均愈合。1例严重感染（2.7%）和1例轻微感染（2.7%）经抗生素成功治疗。无植入物外露病例。进行了2次手术复杂修复和1次择期取出植入物手术。糖尿病和体重指数增加与围手术期总体并发症发生率增加在统计学上相关。
对于肥胖和/或下垂患者，采用胸肌前两阶段 Wise 模式皮肤缩减乳房重建术效果良好，围手术期并发症发生率较低。伤口裂开很常见，但在不需要复杂修复以加快辅助化疗时，通过伤口护理进行处理。感染率和再次手术率较低，所有患者在重建完成时均报告美学效果良好。
