Division of Plastic Surgery, Montefiore Medical Center, Bronx, New York.
J Reconstr Microsurg. 2019 Jul;35(6):445-451. doi: 10.1055/s-0039-1677798. Epub 2019 Feb 4.
Delayed immediate (DI) autologous breast reconstruction consists of immediate postmastectomy tissue expander placement, radiation therapy, and subsequent autologous reconstruction. The decision between timing of reconstructive methods is challenging and remains to be elucidated. We aim to compare patient reported outcomes and quality of life between delayed and DI reconstruction.
A retrospective review of all patients, who underwent autologous breast reconstruction at Montefiore Medical Center from January 2009 to December 2016, was conducted. Patients who underwent postmastectomy radiotherapy were divided into two cohorts: delayed and DI autologous breast reconstruction. Patients were mailed a BREAST-Q survey and their responses, demographic information, complications, and need for revisionary procedures were analyzed.
A total of 79 patients met inclusion criteria: 34.2% ( = 27) in the delayed and 65.8% ( = 52) in the DI group. 77.2% ( = 61) of patients were a minority population. Patients in each cohort had similar baseline characteristics; however, the DI cohort was more likely to have bilateral reconstruction (46.2% [ = 24] vs. 7.4% [ = 2]; = 0.0005) and to have major mastectomy flap necrosis (22.4% [ = 17] vs. 0.0% [ = 0]; = 0.002). Premature tissue expander removal occurred in 17.3% ( = 9) of patients in the DI group. BREAST-Q response rates were 44.4% ( = 12) in the delayed group and 57.7% ( = 30) in the DI group. Responses showed similar satisfaction with their breasts, well-being, and overall outcome.
Delayed and DI autologous breast reconstruction yield similar patient-reported satisfaction; however, patients undergoing DI reconstruction have higher rates of major mastectomy necrosis. Furthermore, patients in the DI group risk premature tissue expander removal.
延迟即刻（DI）自体乳房重建包括即刻乳房切除术后组织扩张器的放置、放射治疗和随后的自体重建。重建方法的时间选择具有挑战性，仍有待阐明。我们旨在比较延迟和 DI 重建之间的患者报告结局和生活质量。
对 2009 年 1 月至 2016 年 12 月在蒙特菲奥雷医疗中心接受自体乳房重建的所有患者进行了回顾性研究。接受乳房切除术放疗的患者分为两组：延迟和 DI 自体乳房重建。向患者邮寄 BREAST-Q 调查，分析他们的反应、人口统计学信息、并发症和需要修正性手术。
共有 79 名患者符合纳入标准：延迟组 34.2%（ = 27），DI 组 65.8%（ = 52）。77.2%（ = 61）的患者为少数族裔。两组患者的基线特征相似；然而，DI 组更有可能进行双侧重建（46.2% [ = 24] 与 7.4% [ = 2]； = 0.0005）和发生重大乳房皮瓣坏死（22.4% [ = 17] 与 0.0% [ = 0]； = 0.002）。DI 组有 17.3%（ = 9）的患者过早去除组织扩张器。延迟组的 BREAST-Q 应答率为 44.4%（ = 12），DI 组为 57.7%（ = 30）。应答结果显示，两组患者对乳房、幸福感和整体结局的满意度相似。
延迟和 DI 自体乳房重建的患者报告满意度相似；然而，接受 DI 重建的患者发生重大乳房皮瓣坏死的风险更高。此外，DI 组的患者有过早去除组织扩张器的风险。
