Verma Richa, Klein Gabriel, Dagum Alexander, Khan Sami, Bui Duc T
Division of Plastic and Reconstructive Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, N.Y.
Plast Reconstr Surg Glob Open. 2019 May 16;7(5):e2224. doi: 10.1097/GOX.0000000000002224. eCollection 2019 May.
Tissue expander-based immediate breast reconstruction is currently the most common technique used for postmastectomy breast reconstruction. During mastectomy, axillary lymph nodes are biopsied to stage patients. The purpose of this study is to investigate postoperative complications with respect to extent of lymph node dissection.
A retrospective review of all patients undergoing tissue expander-based immediate breast reconstruction at our institution from 2010 to 2012 was conducted. Charts were analyzed to determine the association between the absolute number of axillary lymph nodes removed and postreconstructive incidence of skin necrosis, cellulitis, seroma, and expander removal. Independent sample test and linear regression were used to analyze data.
In total, 282 patients with 467 reconstructions were included. Overall incidence of all postoperative complications per breast was 23.8%. Breasts in which a complication occurred had a mean of 6 nodes removed versus 4 nodes in uncomplicated breasts ( = 0.018). Complications were noted at a significantly higher rate in patients who underwent axillary lymph node dissection compared with sentinel lymph node biopsy ( = 0.008). Expander removal and seroma occurred more frequently in breasts that had a greater number of nodes removed ( = 0.006 and = 0.015, respectively). Preoperative radiation resulted in higher incidence of cellulitis and skin necrosis. Postoperative radiation and chemotherapy did not adversely affect reconstruction.
Axillary lymph node removal of >4 nodes confers a greater risk of postreconstructive seroma formation and tissue expander loss in patients undergoing immediate reconstruction following mastectomy. Axillary lymph node dissection has a higher incidence of breast reconstruction complications compared with sentinel lymph node biopsy. Therefore, we encourage plastic surgeons to consider degree of lymphadenectomy when discussing reconstructive options with patients, as this may significantly impact their reconstructive outcome.
基于组织扩张器的即刻乳房重建是目前乳房切除术后乳房重建最常用的技术。在乳房切除术中，会对腋窝淋巴结进行活检以对患者进行分期。本研究的目的是调查与淋巴结清扫范围相关的术后并发症。
对2010年至2012年在我院接受基于组织扩张器的即刻乳房重建的所有患者进行回顾性研究。分析病历以确定切除的腋窝淋巴结绝对数量与重建后皮肤坏死、蜂窝织炎、血清肿和扩张器取出发生率之间的关联。使用独立样本检验和线性回归分析数据。
共纳入282例患者的467次重建。每侧乳房所有术后并发症的总体发生率为23.8%。发生并发症的乳房平均切除6个淋巴结，而未发生并发症的乳房平均切除4个淋巴结（P = 0.018）。与前哨淋巴结活检相比，接受腋窝淋巴结清扫的患者并发症发生率显著更高（P = 0.008）。切除淋巴结数量较多的乳房中扩张器取出和血清肿发生更频繁（分别为P = 0.006和P = 0.015）。术前放疗导致蜂窝织炎和皮肤坏死发生率更高。术后放疗和化疗对重建没有不利影响。
在乳房切除术后即刻重建的患者中，切除超过4个腋窝淋巴结会增加重建后血清肿形成和组织扩张器丢失的风险。与前哨淋巴结活检相比，腋窝淋巴结清扫的乳房重建并发症发生率更高。因此，我们鼓励整形外科医生在与患者讨论重建方案时考虑淋巴结清扫程度，因为这可能会显著影响他们的重建结果。
