From the Division of Plastic Surgery, Department of Surgery, Mayo Clinic.
Rochester, Minn.
Plast Reconstr Surg. 2020 Mar;145(3):619-627. doi: 10.1097/PRS.0000000000006540.
Prepectoral implant-based reconstruction reemerged as a viable approach following recent advances in reconstructive techniques and technology. To achieve successful outcomes, careful patient selection is critical. Obesity increases the risk of complications and has been suggested as a relative contraindication for prepectoral breast reconstruction.
Retrospective chart review of patients who underwent immediate two-stage implant-based reconstruction at the authors' institution was performed. Only women having a body mass index of 30 kg/m or greater were included. Patient demographics, operative details, and surgical outcomes of prepectoral and subpectoral reconstruction were compared.
One hundred ten patients (189 breasts) who underwent prepectoral and 83 (147 breasts) who underwent subpectoral reconstruction were included. Complications were comparable between the two groups. Twelve devices (6.4 percent), including implants and tissue expanders, required explantation in the prepectoral group, and 12 devices (8.2 percent) required explantation in the subpectoral group (p =0.522). Final implant-based reconstruction was achieved in 180 breasts (95.2 percent) in the prepectoral group and 141 breasts (95.9 percent) in the subpectoral group. Regardless of type of reconstruction (prepectoral or subpectoral), for each point increase in body mass index, the odds of complications and device explantation increased by 3.4 percent and 8.6 percent, respectively; and the optimal cutoff to predict higher complications and explantation rates was a body mass index of 34.8 kg/m and 34.1 kg/m, respectively.
Obesity increases complications and failure rates in a positive correlation; however, complications and final reconstruction rates are comparable between the prepectoral and subpectoral groups. The authors believe that obesity should not be a contraindication for prepectoral breast reconstruction but that care should be taken in patients with a body mass index above 35 kg/m.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
随着重建技术和技术的最新进展，胸肌前植入物为基础的重建再次成为一种可行的方法。为了获得成功的结果，仔细选择患者至关重要。肥胖增加了并发症的风险，并被认为是胸肌前乳房重建的相对禁忌症。
对作者所在机构进行的即时两阶段植入物为基础重建的患者进行了回顾性图表审查。只包括体重指数为 30kg/m 或更高的女性。比较了胸肌前和胸肌下重建的患者人口统计学、手术细节和手术结果。
110 例（189 只乳房）接受了胸肌前重建，83 例（147 只乳房）接受了胸肌下重建。两组并发症相当。在胸肌前组中，12 个设备（6.4%），包括植入物和组织扩张器，需要取出，在胸肌下组中，12 个设备（8.2%）需要取出（p=0.522）。在胸肌前组中，180 只乳房（95.2%）最终完成了植入物为基础的重建，在胸肌下组中，141 只乳房（95.9%）最终完成了植入物为基础的重建。无论重建类型（胸肌前或胸肌下），体重指数每增加一个点，并发症和设备取出的几率分别增加 3.4%和 8.6%；预测更高的并发症和取出率的最佳截止值分别为体重指数 34.8kg/m 和 34.1kg/m。
肥胖与并发症和失败率呈正相关增加；然而，胸肌前和胸肌下两组之间的并发症和最终重建率是相当的。作者认为，肥胖不应成为胸肌前乳房重建的禁忌症，但应谨慎对待体重指数高于 35kg/m 的患者。
临床问题/证据水平：治疗，III 级。
