From the Section of Plastic Surgery, Department of Surgery, Yale University School of Medicine.
Plast Reconstr Surg. 2019 Apr;143(4):682e-687e. doi: 10.1097/PRS.0000000000005423.
Two-stage implant breast reconstruction is the most commonly performed breast reconstruction procedure. Limited data exist regarding reconstruction complication rates examined by mastectomy indication.
Patients who underwent two-stage implant breast reconstruction at Yale New Haven Hospital from 2011 to 2017 were included in the study. Perioperative complications were compared. Chi-square analysis, t tests, and Fisher's exact tests were used to determine significant associations. A binary logistic regression was used to determine variables with a significant impact on the likelihood of mastectomy flap necrosis.
Between 2011 and 2017, complete perioperative records were available for 141 patients who underwent 226 mastectomies followed by two-stage tissue expander/permanent implant reconstruction. Of the 226 mastectomies, 134 were therapeutic and 92 were prophylactic. On regression analysis, there were no significant differences in demographics, comorbidities, or mastectomy and reconstructive details between the two breast groups except for there being more modified radical mastectomies in therapeutic breasts (p = 0.003). When comparing complications, there was a significantly higher risk of mastectomy flap necrosis in the therapeutic group (p = 0.017). Therapeutic mastectomies had a 9.5 times higher risk of mastectomy flap necrosis than prophylactic mastectomies when adjusted for confounding variables. There were no significant differences in other reconstructive complications between the two groups.
Patients undergoing therapeutic mastectomies have a significantly higher risk of mastectomy flap necrosis than those undergoing prophylactic mastectomies. Although the underlying cause still needs to be determined, differences in technique may be related to mastectomy flap necrosis.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
两阶段植入物乳房重建是最常进行的乳房重建手术。关于通过乳房切除术指征检查的重建并发症发生率的数据有限。
本研究纳入了 2011 年至 2017 年在耶鲁纽黑文医院接受两阶段植入物乳房重建的患者。比较围手术期并发症。使用卡方检验、t 检验和 Fisher 确切检验来确定显著关联。使用二元逻辑回归来确定对乳房切除术皮瓣坏死可能性有显著影响的变量。
在 2011 年至 2017 年期间，对 141 名接受 226 例乳房切除术和两阶段组织扩张器/永久性植入物重建的患者进行了完整的围手术期记录。在 226 例乳房切除术中有 134 例为治疗性，92 例为预防性。在回归分析中，除了治疗性乳房中更多的改良根治性乳房切除术（p=0.003）外，两组的人口统计学、合并症或乳房切除术和重建细节没有显著差异。当比较并发症时，治疗性乳房组乳房切除术皮瓣坏死的风险明显更高（p=0.017）。调整混杂变量后，治疗性乳房切除术乳房切除术皮瓣坏死的风险比预防性乳房切除术高 9.5 倍。两组之间其他重建并发症无显著差异。
与接受预防性乳房切除术的患者相比，接受治疗性乳房切除术的患者乳房切除术皮瓣坏死的风险显著更高。尽管其根本原因仍需确定，但技术差异可能与乳房切除术皮瓣坏死有关。
临床问题/证据水平：风险，II 级。
