Patel Ashraf A, Borrelli Mimi R, Cai Lawrence, Moshrefi Shawn, Sando Ian C, Lee Gordon K, Nazerali Rahim S
From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, CA.
Ann Plast Surg. 2020 May;84(5S Suppl 4):S329-S335. doi: 10.1097/SAP.0000000000002402.
Delayed-immediate breast reconstruction has traditionally involved placement of tissue expanders (TE) in the subpectoral (SP) position. Development of acellular dermal matrices has renewed interest in the prepectoral (PP) pocket, which avoids extensive muscle manipulation. We compare complication rates between PP and SP TE placement in autologous delayed-immediate breast reconstruction.
A retrospective chart review of patients undergoing autologous, delayed-immediate breast reconstruction at our institution (June 2009 to December 2018) was performed. Demographics, comorbidities, perioperative information, and complication incidence ≤12 months' follow-up were collected from first- and second-stage surgeries. Complications were modeled using univariable and multivariable binary logistic regressions.
A total of 89 patients met the inclusion criteria, and data from 125 breast reconstructions were evaluated. Complication rates following TE placement trended lower in the PP cohort (28.8% vs 37%, P = 0.34). Overall complication rates following autologous reconstruction were significantly lower for PP reconstructions (7.7% vs 23.3%, P = 0.02). Multivariable regression showed TE position (P = 0.01) was a significant predictor of ≥1 complication following autologous reconstruction. Time delay between first- and second-stage surgeries was greater for SP reconstructions (199.7 vs 324.8 days, P < 0.001). Postoperative drains were removed earlier in the PP cohort (8.6 vs 12.0 days, P < 0.001). Mean follow-up time was 331.3 days.
Prepectoral reconstruction in the delayed-immediate autologous reconstruction patient leads to significantly lower complication rates, shorter duration between first- and second-stage surgeries, and shorter times before removal of breast drains compared with SP reconstructions.
传统上，延迟即刻乳房重建涉及在胸大肌后（SP）位置放置组织扩张器（TE）。脱细胞真皮基质的发展重新引发了人们对胸大肌前（PP）腔隙的兴趣，该腔隙可避免广泛的肌肉操作。我们比较了自体延迟即刻乳房重建中PP和SP放置TE的并发症发生率。
对我院（2009年6月至2018年12月）接受自体延迟即刻乳房重建的患者进行回顾性病历审查。收集了一期和二期手术的人口统计学、合并症、围手术期信息以及随访≤12个月的并发症发生率。使用单变量和多变量二元逻辑回归对并发症进行建模。
共有89例患者符合纳入标准，评估了125例乳房重建的数据。PP组TE放置后的并发症发生率呈下降趋势（28.8%对37%，P = 0.34）。PP重建的自体重建后总体并发症发生率显著更低（7.7%对23.3%，P = 0.02）。多变量回归显示TE位置（P = 0.01）是自体重建后≥1种并发症的显著预测因素。SP重建的一期和二期手术之间的时间延迟更长（199.7对324.8天，P < 0.001）。PP组术后引流管拔除时间更早（8.6对12.0天，P < 0.001）。平均随访时间为331.3天。
与SP重建相比，延迟即刻自体重建患者的胸大肌前重建导致并发症发生率显著降低、一期和二期手术之间的持续时间更短以及乳房引流管拔除前的时间更短。
