Munder Beatrix, Andree Christoph, Witzel Christian, Fertsch Sonia, Stambera Peter, Schulz Tino, Fleischer Olaf, Hagouan Mazen, Grüter Lukas, Aufmesser Birgit, Staemmler Katinka, Kornetka Julia, Aldeeri Mohammed, Seidenstücker Katrin, Abu-Ghazaleh Alina, Wolter Andreas
Klinik für Plastische und Ästhetische Chirurgie, Sana Kliniken Düsseldorf GmbH, Düsseldorf, Germany.
Universität Witten-Herdecke, Fakultät für Gesundheit, Witten, Germany.
Geburtshilfe Frauenheilkd. 2020 Jun;80(6):628-638. doi: 10.1055/a-1116-2102. Epub 2020 Apr 16.
Breast cancer is the most common cancer affecting women in Germany. Despite breast-conserving therapy (BCT) being carried out in almost 70% of cases, a high number of women still require complete mastectomy. Prophylactic mastectomy is also indicated for women with a BRCA 1/2 gene mutation. In addition to implant-based heterologous breast reconstruction, autologous breast reconstruction using a DIEP flap has been found to be beneficial, particularly for patients who had prior radiotherapy. This study aims to show that DIEP flap reconstruction surgery is the method of choice for autologous breast reconstruction with a low rate of complications. Autologous breast reconstruction using a DIEP flap was performed in 1124 patients between July 2004 and December 2014. Retrospective study criteria included potential risk factors such as age, BMI, smoking, chemotherapy and/or radiotherapy, and comorbidities as well as outcome parameters such as postoperative complications. Outcomes were evaluated with a mean follow-up of 24 months. A total of 1124 patients underwent 1274 free DIEP flap breast reconstructions, of which 150 were bilateral reconstructions. The primary indication was previous mastectomy in 785 cases, followed by prior implant-based reconstruction in 265 cases. The total flap loss rate was 0.6%. Postoperative surgical revision for abdominal wall hernia was required in 0.2% of cases. The group with a higher BMI and the group of smokers had significantly higher complication rates. Elderly patients (> 65 years), patients who had undergone chemo-/radiotherapy and patients with diabetes did not have higher complication rates. DIEP flap surgery is an excellent option for autologous breast reconstruction, with a low rate of donor site morbidity and low complication rates. DIEP flap surgery carried out in a specialised interdisciplinary breast centre in a standardised clinical setting after prior careful patient selection to take account of risk factors such as high BMI and smoking is a reliable method with a low complication rate and satisfactory long-term reconstruction results.
乳腺癌是德国女性中最常见的癌症。尽管近70%的病例采用了保乳治疗（BCT），但仍有大量女性需要进行全乳切除术。对于携带BRCA 1/2基因突变的女性，也建议进行预防性乳房切除术。除了基于植入物的异体乳房重建外，使用腹壁下动脉穿支皮瓣（DIEP瓣）进行自体乳房重建已被证明是有益的，特别是对于之前接受过放疗的患者。本研究旨在表明，DIEP瓣重建手术是自体乳房重建的首选方法，并发症发生率低。2004年7月至2014年12月期间，对1124例患者进行了使用DIEP瓣的自体乳房重建。回顾性研究标准包括年龄、体重指数（BMI）、吸烟、化疗和/或放疗等潜在风险因素、合并症以及术后并发症等结果参数。平均随访24个月对结果进行评估。共有1124例患者接受了1274次游离DIEP瓣乳房重建，其中150例为双侧重建。主要适应证为既往乳房切除术785例，其次为既往基于植入物的重建265例。皮瓣总丢失率为0.6%。0.2%的病例需要进行腹壁疝术后手术修复。BMI较高的组和吸烟组的并发症发生率显著更高。老年患者（>65岁）、接受过化疗/放疗的患者和糖尿病患者的并发症发生率没有更高。DIEP瓣手术是自体乳房重建的极佳选择，供区发病率低，并发症发生率也低。在经过专门的跨学科乳房中心，在事先仔细选择患者以考虑高BMI和吸烟等风险因素后，在标准化临床环境中进行的DIEP瓣手术是一种可靠的方法，并发症发生率低，长期重建效果令人满意。
