Department of Plastic Surgery, University Medical Center Groningen, Groningen, The Netherlands.
Department of Plastic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands.
Scand J Surg. 2020 Jun;109(2):143-150. doi: 10.1177/1457496919826711. Epub 2019 Feb 3.
The aim of this study was to evaluate the effect of smoking and body mass index on the occurrence of complications after alloplastic breast reconstruction.
A consecutive series of 56 patients treated with immediate or delayed alloplastic breast reconstruction, including six cases combined with latissimus dorsi flap, at three hospitals between 2012 and 2018 were included. Complications were scored and defined according to Clavien-Dindo. To evaluate the impact of smoking, body mass index, and other potential risk factors on the occurrence of any and severe complications, univariate and multivariate logistic regression analyses were applied to estimate odds ratios and 95% confidence intervals.
In 56 patients, 22 patients had a complication. As much as 46% of smokers had severe complications compared to 18% of non-smokers. Of patients with body mass index ⩾ 25, 40% had severe complications compared to 10% with body mass index < 25. Smokers had eight times more chance of developing severe complications than non-smokers (OR = 8.0, = 0.02). Patients with body mass index ⩾ 25 had almost 10 times more severe complications compared to patients with body mass index ⩽ 25 (OR = 9.9, = 0.009). No other risk factors were significant.
Smoking and body mass index ⩾ 25 both increased the complication rate to such an extent that patients should be informed about their increased risk for complications following alloplastic breast reconstruction and on these grounds surgeons may delay alloplastic breast reconstruction. It is an ethical dilemma whether one should deny overweight and obese patients and those who smoke an immediate alloplastic breast reconstruction. For both life style interventions, adequate guidance should be made available.
本研究旨在评估吸烟和体重指数对假体乳房重建后并发症发生的影响。
纳入了 2012 年至 2018 年间在三所医院接受即刻或延迟假体乳房重建的 56 例患者（包括 6 例合并背阔肌皮瓣）的连续系列病例。根据 Clavien-Dindo 对并发症进行评分和定义。为了评估吸烟、体重指数和其他潜在危险因素对任何严重并发症发生的影响，采用单因素和多因素逻辑回归分析来估计优势比和 95%置信区间。
在 56 例患者中，22 例发生了并发症。吸烟者发生严重并发症的比例高达 46%，而非吸烟者为 18%。体重指数≥25 的患者中，有 40%发生严重并发症，而体重指数<25 的患者中，有 10%发生严重并发症。吸烟者发生严重并发症的几率是非吸烟者的 8 倍（OR=8.0，=0.02）。体重指数≥25 的患者发生严重并发症的几率是非吸烟者的近 10 倍（OR=9.9，=0.009）。其他危险因素均无统计学意义。
吸烟和体重指数≥25 均显著增加了并发症的发生率，因此应该告知患者假体乳房重建后并发症的风险增加，并在此基础上，外科医生可以延迟假体乳房重建。对于超重和肥胖患者以及吸烟者，是否应拒绝立即进行假体乳房重建，这是一个伦理困境。对于这两种生活方式干预，应提供充分的指导。
