Department of Oncologic and Reconstructive Breast Surgery, "Breast Unit Integrata di Livorno, Cecina, Piombino, Elba, Azienda USL Toscana Nord Ovest", Italy.
Plastic Surgery Unit, Department of Surgery "P. Valdoni", Sapienza University, Rome, Italy.
Eur J Surg Oncol. 2019 Aug;45(8):1357-1363. doi: 10.1016/j.ejso.2019.02.009. Epub 2019 Feb 10.
Recently prepectoral breast reconstruction (PBR) has showed acceptable outcomes in the short-term. There are few evidence on long-term results and variables which could influence surgical safety. So far, no specific guidelines or indications have been developed for prepectoral technique and heterogeneous inclusion criteria had been used in previous reports. This study revises a series of 397 patients. We conducted a retrospective comparative analysis of risk factors and outcomes between patients undergoing direct to-implant (DTI) and patients undergoing two-stages expander-assisted (TSE) PBR. Univariate binary logistic regression was performed to investigate the association between the incidence of postoperative and aesthetic complications and several variables. 521 breasts were included in the analysis, with an average follow-up of 38 months. 210 patients underwent DTI and 187 TSE PBR. No statistical differences were found between the two populations in term of the characteristics of patients, surgeries and outcomes. Binary logistic regression found no significant association in the TSE group. In the DTI group, a significant association was found between surgical complications and BMI and adjuvant radiotherapy. The association remained significant only for BMI, when investigated with the onset of aesthetic complications. Lower BMI and adjuvant radiotherapy are significantly associated to a higher risk of developing a surgical complication in DTI PBR. Patients at lowest BMI with DTI are prone to develop an aesthetic complication. According to this analysis, we suggest to carefully choose candidates for PBR and propose new selection criteria for subcutaneous techniques.
近期，胸肌前置乳房重建术（PBR）在短期效果上表现出了良好的结果。但是目前关于其长期效果和影响手术安全性的因素的相关证据较少。迄今为止，还没有针对胸肌前置技术的具体指南或适应证，并且在之前的报告中使用了不同的纳入标准。本研究回顾性分析了 397 例患者，对直接置管（DTI）和两阶段扩张器辅助（TSE）PBR 患者的危险因素和结果进行了对比分析。使用单变量二项逻辑回归分析，研究了术后和美学并发症发生率与几个变量之间的相关性。对 521 例乳房进行了分析，平均随访 38 个月。210 例患者接受了 DTI，187 例患者接受了 TSE PBR。两组患者在患者特征、手术和结果方面无统计学差异。二项逻辑回归分析发现 TSE 组中没有显著相关性。在 DTI 组中，手术并发症与 BMI 和辅助放疗之间存在显著相关性。当研究美学并发症的发病情况时，仅 BMI 与手术并发症之间的相关性仍然显著。较低的 BMI 和辅助放疗与 DTI PBR 中发生手术并发症的风险增加显著相关。BMI 最低的 DTI 患者更容易发生美学并发症。根据本分析，我们建议仔细选择 PBR 患者，并为皮下技术提出新的选择标准。
