From the Department of Surgery, Mayo Clinic.
Mayo Clinic Alix School of Medicine, Phoenix.
Ann Plast Surg. 2021 May 1;86(5):508-511. doi: 10.1097/SAP.0000000000002583.
The purpose of this study is to evaluate how prior breast augmentation impacts rates of complications and risk for reoperation after mastectomy with concurrent breast reconstruction.
Patients undergoing nipple-sparing, skin-sparing, or simple mastectomy with implant-based reconstruction from 2008 to 2018 were identified in a prospective database. Postoperative complications and reoperations were then analyzed comparing patients with prior augmentation to patients without history of previous breast surgery.
A total of 468 patients were identified with a median follow-up of 4 years. Of these, 72 had prior augmentation mammoplasty. These patients underwent nipple-sparing (52, 72%), skin-sparing (15, 21%), or simple (5, 7%) mastectomy with immediate direct-to-implant (46, 61%) or tissue expander (26, 35%) reconstruction. On univariate analysis, this cohort had a lower body mass index (23.3 vs 25.3, P = 0.003), a higher rate of nipple-sparing mastectomy (72% vs 54%, P = 0.01), and a higher prevalence of stage I disease (44% vs 33%, P = 0.04). Differences in age, comorbidities, reconstructive techniques, tumor size, and neoadjuvant/adjuvant therapies were not significant. Overall complication rate between patients with or without prior augmentation did not significantly differ (51% vs 50%, P = 0.83); no significant differences in rates of surgical site infection, hematoma, mastectomy skin flap/wound necrosis, nipple complications, implant loss, or capsular contracture were found. Analysis of reoperations between patients with and without prior augmentation revealed no significant differences in average number of subsequent planned, unplanned, or total reoperations. On multivariate analysis, prior breast augmentation was found to be associated with significantly increased risk for undergoing ≥1 unplanned reoperation (odds ratio, 2.28; 95% confidence interval, 1.28-4.05, P = 0.005).
Prior augmentation mammoplasty does not significantly affect rates of postoperative complications after mastectomy with concurrent reconstruction. Although prior augmentation does not affect number of subsequent reoperations on average, it does increase the risk of experiencing 1 or more unplanned reoperation after mastectomy with reconstruction.
本研究旨在评估既往隆乳术对同期乳房重建乳房切除术的并发症发生率和再手术风险的影响。
在一个前瞻性数据库中，确定了 2008 年至 2018 年间行保留乳头乳晕皮瓣的、保留皮肤的或单纯乳房切除术并接受基于植入物的重建的患者。然后比较有既往隆乳术史的患者和无既往乳房手术史的患者的术后并发症和再手术情况。
共确定了 468 例患者，中位随访时间为 4 年。其中 72 例有既往隆乳术史。这些患者接受了保留乳头乳晕皮瓣的（52 例，72%）、保留皮肤的（15 例，21%）或单纯（5 例，7%）乳房切除术，行即刻直接置管（46 例，61%）或组织扩张器（26 例，35%）重建。单因素分析显示，该组患者的体重指数较低（23.3 vs 25.3，P = 0.003），保留乳头乳晕皮瓣的乳房切除术比例较高（72% vs 54%，P = 0.01），Ⅰ期疾病的发生率较高（44% vs 33%，P = 0.04）。患者的年龄、合并症、重建技术、肿瘤大小、新辅助/辅助治疗的差异无统计学意义。有或无既往隆乳术的患者之间的总体并发症发生率无显著差异（51% vs 50%，P = 0.83）；手术部位感染、血肿、乳房切除术皮瓣/伤口坏死、乳头并发症、植入物丢失或包膜挛缩的发生率无显著差异。有或无既往隆乳术的患者之间的再手术分析显示，计划再手术、非计划再手术或总再手术的平均次数无显著差异。多因素分析显示，既往隆乳术与接受≥1 次非计划再手术的风险显著增加相关（比值比，2.28；95%置信区间，1.28-4.05，P = 0.005）。
既往隆乳术不会显著影响同期乳房重建乳房切除术的术后并发症发生率。尽管既往隆乳术对平均再手术次数没有影响，但它确实增加了乳房切除术后重建发生 1 次或多次非计划再手术的风险。
