From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center; Division of Plastic Surgery, Department of Surgery, McMaster University; Section of Plastic Surgery, Department of Surgery, and Center for Statistical Consultation and Research, Department of Biostatistics, University of Michigan; and Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School.
Plast Reconstr Surg. 2019 Dec;144(6):1280-1290. doi: 10.1097/PRS.0000000000006225.
Rates of breast reconstruction following mastectomy continue to increase. The objective of this study was to determine the frequency of elective revision surgery and the number of procedures required to achieve a stable breast reconstruction 2 years after mastectomy.
Women undergoing first-time breast reconstruction after mastectomy were enrolled and followed for 2 years, with completion of reconstruction occurring in 1996. Patients were classified based on the absence or presence of complications. Comparisons within cohorts were performed to determine factors associated with revisions and total procedures. Mixed-effects regression modeling identified factors associated with elective revisions and total operations.
Overall, 1534 patients (76.9 percent) had no complications, among whom 40.2 percent underwent elective revisions. The average number of elective revisions differed by modality (p < 0.001), with abdominally based free autologous reconstruction patients undergoing the greatest number of elective revisions (mean, 0.7). The mean total number of procedures also differed (p < 0.001), with tissue expander/implant reconstruction patients undergoing the greatest total number of procedures (mean, 2.4). Complications occurred in 462 patients (23.1 percent), with 67.1 percent of these patients undergoing elective revisions, which was significantly higher than among patients without complications (p < 0.001). The mean number of procedures again differed by modality (p < 0.001) and followed similar trends, but with an increased mean number of revisions and procedures overall. Mixed-effects regression modeling demonstrated that patients experiencing complications had increased odds of undergoing elective revision procedures (OR, 3.2; p < 0.001).
Breast reconstruction patients without complications undergo over two procedures on average to achieve satisfactory reconstruction, with 40 percent electing revisions. If a complication occurs, the number of procedures increases.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
乳房切除术（mastectomy）后乳房重建的比例持续增加。本研究旨在确定乳房重建术后择期修复手术的频率和达到乳房重建术后 2 年稳定状态所需的手术次数。
对 1996 年首次接受乳房切除术（mastectomy）后乳房重建的患者进行入组和 2 年随访，完成重建。患者根据是否存在并发症进行分类。在队列内进行比较，以确定与修复术和总手术相关的因素。混合效应回归模型确定了与择期修复术和总手术相关的因素。
总体而言，1534 例（76.9%）患者无并发症，其中 40.2%的患者行择期修复术。不同治疗方式的平均择期修复术次数不同（p < 0.001），腹部游离自体组织重建患者的择期修复术次数最多（平均 0.7 次）。总的手术次数也不同（p < 0.001），组织扩张器/植入物重建患者总的手术次数最多（平均 2.4 次）。462 例（23.1%）患者发生并发症，其中 67.1%的患者行择期修复术，明显高于无并发症患者（p < 0.001）。不同治疗方式的平均手术次数也不同（p < 0.001），且呈现相似的趋势，但总的来说，修复术和手术次数都有所增加。混合效应回归模型显示，发生并发症的患者行择期修复术的可能性增加（OR，3.2；p < 0.001）。
无并发症的乳房重建患者平均需进行 2 次以上手术才能达到满意的重建效果，其中 40%的患者选择修复术。如果发生并发症，手术次数会增加。
临床问题/证据水平：风险，Ⅱ级。
