Patel Ashraf A, Martin Shanique A, Cheesborough Jennifer E, Lee Gordon K, Nazerali Rahim S
Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, 770 Welch Rd, Suite 400, Stanford, CA 94305, United States; College of Medicine, SUNY Upstate Medical University, Syracuse, NY, United States.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, 770 Welch Rd, Suite 400, Stanford, CA 94305, United States.
J Plast Reconstr Aesthet Surg. 2021 Apr;74(4):792-799. doi: 10.1016/j.bjps.2020.10.008. Epub 2020 Oct 21.
Patients often pursue revisions following implant-based breast reconstruction (IBR) to achieve their desired result. Fat grafting is a popular choice for patients and can be performed at second stage reconstruction or at a future date as a revisionary surgery. We investigate the best time to fat graft in IBR by comparing the outcomes of patients who received fat grafting during implant placement with those who pursued fat grafting during a tertiary procedure.
We retrospectively reviewed the charts of 157 patients (270 breasts) who underwent immediate two-stage IBR and fat grafting over a five-year period (2012-2016) at our institution. Two cohorts were created based on timing of first fat grafting procedure: immediate (IFG) and delayed (DFG). Charts were reviewed for postoperative complications or revisions.
Complication rates were lower when fat grafting was performed during the second stage (p = 0.0331). Patients in the DFG cohort required more than one additional revision (p < 0.001) until the completion of reconstruction. Patients in the IFG cohort completed their reconstruction and revisions more than one year earlier than the DFG cohort (p < 0.001). Multivariable regressions showed IFG to be associated with decreased revisions (p < 0.001) and total fat grafting procedures (p = 0.008).
These results indicate that fat grafting at the second stage does not increase overall complication rates, require fewer additional surgeries, and enables patients to reach their desired aesthetic appearance in a shorter time frame. Fewer total surgeries translate not only to a more economical option but also obviate the risk of complications that come with additional surgeries.
在基于植入物的乳房重建（IBR）后，患者常常寻求修复手术以达到理想效果。脂肪移植是患者常用的选择，可在二期重建时进行，也可在日后作为修复手术进行。我们通过比较在植入物放置期间接受脂肪移植的患者与在三期手术中进行脂肪移植的患者的结果，来研究IBR中脂肪移植的最佳时机。
我们回顾性分析了2012年至2016年期间在我院接受即刻两阶段IBR和脂肪移植的157例患者（270个乳房）的病历。根据首次脂肪移植手术的时间创建了两个队列：即刻（IFG）和延迟（DFG）。对病历进行术后并发症或修复情况的审查。
在二期进行脂肪移植时并发症发生率较低（p = 0.0331）。DFG队列中的患者在重建完成前需要进行不止一次额外的修复（p < 0.001）。IFG队列中的患者比DFG队列提前一年多完成重建和修复（p < 0.001）。多变量回归显示IFG与修复次数减少（p < 0.001）和脂肪移植总手术次数减少（p = 0.008）相关。
这些结果表明，二期脂肪移植不会增加总体并发症发生率，所需的额外手术较少，并能使患者在更短的时间内达到理想的美学外观。手术总数减少不仅意味着更经济的选择，还消除了额外手术带来的并发症风险。
