Keck School of Medicine of USC, Los Angeles, California, USA.
Department of Surgery, Keck Hospital of USC, Los Angeles, California, USA.
J Plast Reconstr Aesthet Surg. 2021 May;74(5):931-944. doi: 10.1016/j.bjps.2020.11.027. Epub 2020 Dec 5.
Immediate post-mastectomy autologous breast reconstruction in breast cancer patients requiring post-mastectomy radiation therapy (PMRT) minimizes the number of operations that patients must undergo and alleviates the psychological impact of living without a breast. However, the safety and impact of radiation on the reconstructed breast remains to be established. This study aimed to compare immediate versus delayed autologous reconstruction in the setting of PMRT to determine the optimal sequencing of reconstruction and adjuvant radiation.
A systematic review of the literature identified 292 studies meeting criteria for full-text review, 44 of which underwent meta-analysis. This represented data on 1,927 immediate reconstruction (IR) patients and 1,546 delayed reconstruction (DR) patients (3,473 total patients). Early complications included flap loss, fat necrosis, thrombosis, seroma, hematoma, infection, and skin dehiscence. Late complications included fibrosis or contracture, severe asymmetry, hyperpigmentation, and decreased flap volume.
Immediate breast reconstruction did not demonstrate significantly increased complication rates. Reported mean complication rates in IR versus DR groups, respectively, were fat necrosis 14.91% and 8.12% (p = 0.076), flap loss 0.99% and 1.80% (p = 0.295), hematoma 1.91% and 1.14% (p = 0.247), infection 11.66% and 4.68% (p = 0.155), and thrombosis 1.51% and 3.36% (p = 0.150). Seroma rates were significantly lower in the immediate cohort at 2.69% versus 10.57% in the delayed cohort (p = 0.042).
Complication rates are comparable between immediate and delayed breast reconstruction in the setting of PMRT. Given the patient benefits incurred by an IR algorithm, immediate autologous breast reconstruction should be considered as a viable treatment option in patients requiring PMRT.
在需要接受乳房切除术放疗（PMRT）的乳腺癌患者中，即刻乳房切除术自体重建术可最大程度减少患者必须接受的手术次数，并减轻失去乳房的心理影响。然而，辐射对重建乳房的安全性和影响仍有待确定。本研究旨在比较 PMRT 环境下即刻与延迟自体重建术，以确定重建和辅助放疗的最佳顺序。
对文献进行系统回顾，确定了符合全文审查标准的 292 项研究，其中 44 项进行了荟萃分析。这代表了 1927 例即刻重建（IR）患者和 1546 例延迟重建（DR）患者的数据（总计 3473 例患者）。早期并发症包括皮瓣坏死、脂肪坏死、血栓形成、血清肿、血肿、感染和皮肤裂开。晚期并发症包括纤维化或挛缩、严重不对称、色素沉着过度和皮瓣体积减少。
即刻乳房重建并未显示出明显增加的并发症发生率。IR 与 DR 组分别报告的平均并发症发生率为脂肪坏死 14.91%和 8.12%（p=0.076）、皮瓣坏死 0.99%和 1.80%（p=0.295）、血肿 1.91%和 1.14%（p=0.247）、感染 11.66%和 4.68%（p=0.155）以及血栓形成 1.51%和 3.36%（p=0.150）。即刻组的血清肿发生率明显较低，为 2.69%，而延迟组为 10.57%（p=0.042）。
PMRT 环境下即刻和延迟乳房重建的并发症发生率相当。鉴于即刻自体重建术为患者带来的获益，对于需要 PMRT 的患者，应将即刻自体乳房重建术视为一种可行的治疗选择。
