Freniere Brian, Irwin Timothy, Guldbrandsen Gretchen, Lafleur Emily H, Dominici Laura, Sturgeon Daniel, Chun Yoon S
From the Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital.
Division of Breast Surgery, Department of Surgery.
Ann Plast Surg. 2020 May;84(5):507-511. doi: 10.1097/SAP.0000000000002087.
External beam radiation in the mantle field has been a mainstay of therapy for Hodgkin's lymphoma for decades. The incidence of breast cancer in patients treated with mantle radiation is known to be elevated. Few studies have examined outcomes of breast reconstruction in this high-risk group. The current study presents the largest series of immediate breast reconstruction in this population and aims to evaluate reconstructive outcomes and examine differences between implant-based and autologous reconstructions.
A retrospective review of records from a 10-year period at 2 institutions was undertaken. Patients treated with mantle radiation for Hodgkin's lymphoma who subsequently underwent mastectomy with immediate reconstruction were identified. Patient demographics, clinical characteristics, and outcomes including complications and operative revisions were gathered. Univariate and multivariate analyses were conducted to assess differences between implant-based and autologous reconstructions.
A total of 97 breast reconstructions were performed in 52 patients. Seventy-nine reconstructions were implant-based, and 18 were autologous. Patients with implant-based reconstructions were older than autologous reconstructions (47 ± 8.8 years vs 42 ± 6.5 years, P < 0.05). Both groups had long-term follow-up; however, the mean follow-up duration was shorter in the implant-based compared with the autologous group (5 years vs 8.3 years; P < 0.05). Otherwise, the groups were similar with respect to BMI, medical comorbidities, oncologic diagnosis, and therapy. The interval between mantle radiation and reconstruction was comparable for implant-based and autologous groups (23.4 ± 9 years vs 21.3 ± 6.1 years, P = 0.6). The overall complication rate of breast reconstruction was not statistically different between the implant-based and autologous groups (35% vs 16%, P = 0.16). Three implant-based reconstructions (3.7%) required explantation. There were no complete flap losses in the autologous group. An associated 6-fold higher rate of unplanned revisions was observed with the autologous reconstruction group compared with the implant-based reconstruction group (odds ratio, 6.09; 95% confidence interval, 1.14-32.48; P = 0.035).
In this study, long-term follow-up suggests immediate breast reconstruction in patients with prior mantle radiation can be achieved safely with an acceptable complication profile utilizing either implant-based or autologous techniques. Autologous breast reconstruction is linked with a higher rate of revisions compared with implant-based breast reconstruction in this study population.
几十年来，斗篷野体外照射一直是霍奇金淋巴瘤治疗的主要手段。已知接受斗篷野放疗的患者患乳腺癌的几率会升高。很少有研究探讨这一高危人群乳房重建的效果。本研究展示了该人群中最大规模的一期乳房重建系列，并旨在评估重建效果，以及研究基于植入物的重建和自体组织重建之间的差异。
对两家机构10年期间的记录进行回顾性研究。确定那些因霍奇金淋巴瘤接受斗篷野放疗，随后接受乳房切除并一期重建的患者。收集患者的人口统计学资料、临床特征以及包括并发症和手术翻修在内的结果。进行单因素和多因素分析，以评估基于植入物的重建和自体组织重建之间的差异。
52例患者共进行了97次乳房重建。79次重建基于植入物，18次为自体组织重建。接受基于植入物重建的患者比接受自体组织重建的患者年龄更大（47±8.8岁对42±6.5岁，P<0.05）。两组均进行了长期随访；然而，基于植入物重建组的平均随访时间比自体组织重建组短（5年对8.3年；P<0.05）。除此之外，两组在体重指数、内科合并症、肿瘤诊断和治疗方面相似。基于植入物重建组和自体组织重建组在斗篷野放疗与重建之间的间隔时间相当（23.4±9年对21.3±6.1年，P = 0.6）。基于植入物的重建组与自体组织重建组乳房重建的总体并发症发生率无统计学差异（35%对16%，P = 0.16）。3次基于植入物的重建（3.7%）需要取出植入物。自体组织重建组没有皮瓣完全坏死的情况。与基于植入物的重建组相比，自体组织重建组的计划外翻修率高出6倍（优势比，6.09；95%置信区间，1.14 - 32.48；P = 0.035）。
在本研究中，长期随访表明，对于既往接受过斗篷野放疗的患者，采用基于植入物或自体组织技术进行一期乳房重建均可安全实现，并发症情况可接受。在本研究人群中，自体组织乳房重建与基于植入物的乳房重建相比，翻修率更高。
