肥胖患者的乳房微创手术重建：是否优于组织扩张器/植入物重建？

Microsurgical Breast Reconstruction in the Obese: A Better Option Than Tissue Expander/Implant Reconstruction?

机构信息

From the Department of Plastic Surgery, Medical College of Wisconsin; the Division of Plastic Surgery, Intermountain Healthcare; and the Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine.

出版信息

Plast Reconstr Surg. 2019 Sep;144(3):539-546. doi: 10.1097/PRS.0000000000005897.

DOI:10.1097/PRS.0000000000005897

PMID:31460996

Abstract

BACKGROUND

Obesity has reached epidemic proportions, with 72 million people in the United States classified as obese in 2010. This significant increase in obese patients is reflected in the breast cancer population seeking breast reconstruction. Previous studies demonstrated increased complication rates and decreased satisfaction in obese patients undergoing breast reconstruction. This study aims to directly compare prosthetic and autologous reconstruction in the obese population by evaluating surgical outcomes and patient satisfaction.

METHODS

In an institutional review board-approved study, a retrospective chart review was conducted on patients with a body mass index of 30.0 kg/m or greater who underwent breast cancer reconstruction after mastectomy with either free tissue transfer from the abdomen or prosthetic reconstruction over a 3-year period. The authors identified 96 patients with 141 reconstructions. Demographic, intraoperative, and postoperative variables were collected. All patients were sent the BREAST-Q questionnaire by means of mail to study the impact and effectiveness of breast surgery from the patient's perspective. Statistical analysis was completed with Fisher's exact test, Mantel-Haenszel chi-square test, Pearson chi square test, or Mann-Whitney-Wilcoxon test.

RESULTS

Prosthetic-based breast reconstruction was associated with increased major breast complications (p < 0.001), mastectomy skin flap necrosis (p = 0.009), infection (0.006), and overall reconstructive failure (p < 0.0001) compared with autologous reconstruction. When evaluating the results of the BREAST-Q studies, the autologous reconstruction group had improved satisfaction with breasts (p < 0.0001), satisfaction with outcome (p = 0.01), psychosocial well-being (p = 0.007), and sexual well-being (p = 0.006).

CONCLUSION

In the obese population, reconstruction with free tissue transfer from the abdomen resulted in decreased complications of the breast reconstruction site and improved patient satisfaction with outcomes compared with prosthetic reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

摘要

背景

肥胖已达到流行程度，2010 年美国有 7200 万人被归类为肥胖。这种肥胖患者的显著增加反映在寻求乳房重建的乳腺癌患者中。先前的研究表明，肥胖患者接受乳房重建的并发症发生率增加，满意度降低。本研究旨在通过评估手术结果和患者满意度，直接比较肥胖人群中假体和自体重建。

方法

在机构审查委员会批准的研究中，对 3 年内因乳房切除术接受腹部游离组织转移或假体重建的体重指数为 30.0kg/m 或更高的乳腺癌重建患者进行回顾性病历回顾。作者确定了 96 名患者的 141 次重建。收集了人口统计学、术中及术后变量。所有患者均通过邮件收到 BREAST-Q 问卷，以从患者角度研究乳房手术的影响和效果。使用 Fisher 确切检验、Mantel-Haenszel χ2 检验、Pearson χ2 检验或 Mann-Whitney-Wilcoxon 检验进行统计分析。

结果

与自体重建相比，假体乳房重建与主要乳房并发症（p < 0.001）、乳房皮瓣坏死（p = 0.009）、感染（0.006）和整体重建失败（p < 0.0001）增加有关。在评估 BREAST-Q 研究结果时，自体重建组对乳房的满意度（p < 0.0001）、对结果的满意度（p = 0.01）、心理社会幸福感（p = 0.007）和性幸福感（p = 0.006）均有所改善。