胸肌前与胸肌后入路行保留乳头乳晕乳房切除术的即刻术后并发症比较
Acute Postoperative Complications in Prepectoral versus Subpectoral Reconstruction following Nipple-Sparing Mastectomy.
机构信息
From the Department of Surgery, Division of Breast Surgery, and the Department of Plastic Surgery, MedStar Georgetown University Hospital; and the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health.
出版信息
Plast Reconstr Surg. 2020 Dec;146(6):715e-720e. doi: 10.1097/PRS.0000000000007326.
BACKGROUND
Nipple-sparing mastectomy is associated with improved aesthetics and oncologic safety. Recently, there has been a resurgence in prepectoral reconstruction. Because of limited data comparing complication rates on patients undergoing prepectoral breast reconstruction, this study compared 30-day postoperative complications by plane of prosthetic placement.
METHODS
A retrospective review was conducted on all consecutive patients undergoing nipple-sparing mastectomy with implant-based reconstruction with either prepectoral or subpectoral placement from 2014 to 2018. The primary outcome was a composite, acute 30-day postoperative complication, including nipple-areola complex necrosis, mastectomy flap necrosis, wound dehiscence, infection, hematoma, and seroma. Secondary outcomes included nipple loss and rates of unintended reoperations. Univariate and mixed effects multivariate logistic regression were used to compare outcomes.
RESULTS
A total of 228 patients and 405 breasts were included in the final cohort, with 202 in the subpectoral cohort and 203 in the prepectoral cohort. The overall complication rate was 7.65 percent, with no significant difference between subpectoral and prepectoral cohorts (9.41 percent versus 5.91 percent, respectively; p = 0.148). Prepectoral reconstruction was associated with significantly reduced ischemic complications, including nipple loss because of necrosis (2.97 percent versus 0.49 percent, respectively; p = 0.015) and mastectomy flap necrosis (5.45 percent versus 0 percent; p = 0.003). There were no significant differences in rates of infection, hematoma, seroma, or implant loss/exchange.
CONCLUSIONS
Prepectoral reconstruction is associated with similar overall 30-day postoperative complications and reoperations compared to traditional subpectoral implants. However, prepectoral reconstruction was associated with significantly decreased ischemic complications, including mastectomy flap necrosis and nipple-areola complex loss because of necrosis.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
背景
保留乳头的乳房切除术与改善美观和肿瘤安全性相关。最近，胸肌前置重建术又重新兴起。由于比较接受胸肌前置乳房重建患者并发症发生率的相关数据有限，本研究通过假体放置平面比较了 30 天术后并发症。
方法
回顾性分析了 2014 年至 2018 年期间连续接受保留乳头的乳房切除术联合假体植入的患者，假体分别置于胸肌下或胸肌前置。主要结局为复合的、急性 30 天术后并发症，包括乳头乳晕复合体坏死、乳房皮瓣坏死、伤口裂开、感染、血肿和血清肿。次要结局包括乳头丢失和非计划再次手术的发生率。采用单变量和混合效应多变量逻辑回归比较结局。
结果
共有 228 例患者和 405 个乳房纳入最终队列，其中胸肌下组 202 例，胸肌前置组 203 例。总并发症发生率为 7.65%，胸肌下组和胸肌前置组无显著差异（分别为 9.41%和 5.91%；p=0.148）。胸肌前置重建与显著减少缺血性并发症相关，包括因坏死导致的乳头丢失（分别为 2.97%和 0.49%；p=0.015）和乳房皮瓣坏死（分别为 5.45%和 0%；p=0.003）。感染、血肿、血清肿或假体丢失/更换的发生率无显著差异。
结论
与传统胸肌下假体相比，胸肌前置重建与相似的 30 天术后总体并发症和再次手术率相关。然而，胸肌前置重建与显著减少缺血性并发症相关，包括乳房皮瓣坏死和因坏死导致的乳头乳晕复合体丢失。
临床问题/证据水平：治疗性，III 级。
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