Julien L, Genet J, Leymarie N, Honart J-F, Rimareix F, Mazouni C, Kolb F, De Frémicourt K, Conversano A, Marchal F, Simon E, Brix M, Sarfati B
Department of plastic and maxillofacial surgery, hôpital Cenral, CHRU Nancy, 54000 Nancy, France.
Department of plastic and maxillofacial surgery, hôpital Cenral, CHRU Nancy, 54000 Nancy, France.
Ann Chir Plast Esthet. 2020 Jun;65(3):181-197. doi: 10.1016/j.anplas.2019.12.002. Epub 2020 Jan 29.
Breast cancer and its treatment remains a public health problem. There is still a lack of epidemiological data concerning complications and aesthetic results bound to radiotherapy after an immediate breast reconstruction. The objective of this study was to compare outcomes of immediate breast reconstruction regardless to the use of radiotherapy (history of radiotherapy or adjuvant radiation therapy), in order to determine risk factor of complications and bad aesthetic results.
We conducted a retrospective study between January 2014 and December 2016 at the hospital "Gustave Roussy" in Paris, concerning breast cancer patients who needed immediate breast reconstruction after total mastectomy. The primary endpoint was to assess the failure rate of reconstruction and the aesthetic result, the secondary endpoint assessed the early and late rate of complications. We realized a multivariate analysis in order to identify risks factors that may predict complications.
Three hundred and thirty three patients have been included: 157 in the "radiotherapy group" compared to 176 in the "no radiotherapy group". Preoperative characteristics were comparable. Average follow-up was between 1 and 3years without missing. Patients who benefited from radiotherapy had an equal risk failure of reconstruction. The subgroup analysis revealed non-significant differences: 12.7% failure rate reconstruction in the "radiotherapy group" vs. 12.5%. We could notify a better rate of "excellent results" in the "no radiotherapy group": 35% vs. 8.2%. Secondary outcomes were comparable.
Radiotherapy related to immediate breast reconstruction didn't increase the failure rate of reconstruction or aesthetic results, comparatively to non-irradiated patients. It is therefore permissible to suggest an immediate breast reconstruction to any patients which would benefit from a total mastectomy followed by radiotherapy; in order to prevent them from a secondary breast reconstruction, who could be physically and psychologically more impactful.
乳腺癌及其治疗仍是一个公共卫生问题。关于即刻乳房重建术后放疗相关并发症和美学效果的流行病学数据仍然缺乏。本研究的目的是比较即刻乳房重建的结果，无论是否接受放疗（放疗史或辅助放疗），以确定并发症和不良美学效果的危险因素。
我们于2014年1月至2016年12月在巴黎古斯塔夫·鲁西医院进行了一项回顾性研究，对象为全乳切除术后需要即刻乳房重建的乳腺癌患者。主要终点是评估重建失败率和美学效果，次要终点是评估早期和晚期并发症发生率。我们进行了多变量分析，以确定可能预测并发症的危险因素。
共纳入333例患者：“放疗组”157例，“非放疗组”176例。术前特征具有可比性。平均随访时间为1至3年，无失访。接受放疗的患者重建失败风险相同。亚组分析显示无显著差异：“放疗组”重建失败率为12.7%，“非放疗组”为12.5%。我们注意到“非放疗组”的“优秀结果”率更高：35%对8.2%。次要结果具有可比性。
与未接受放疗的患者相比，即刻乳房重建相关的放疗并未增加重建失败率或影响美学效果。因此，对于任何将受益于全乳切除术后放疗的患者，建议进行即刻乳房重建；以避免他们进行二次乳房重建，二次乳房重建可能对身体和心理造成更大影响。
