Department of Plastic and Reconstructive Surgery, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK.
Department of Plastic and Reconstructive Surgery, Erasmus Medical Centre Rotterdam, Rotterdam, the Netherlands.
Aesthet Surg J. 2021 Jun 14;41(7):NP763-NP770. doi: 10.1093/asj/sjab028.
There is limited evidence available in the literature with regard to the complication profile of mastectomy and immediate prosthetic reconstruction in augmented patients.
The aim of this systematic review and meta-analysis was to compare postoperative complications between women with vs without prior augmentation undergoing skin- or nipple-sparing mastectomy and immediate prosthetic reconstruction.
A systematic search was conducted in February 2020 for studies comparing women with vs without prior augmentation undergoing skin- or nipple-sparing mastectomy and immediate prosthetic reconstruction with documentation of postoperative complications. Outcomes analyzed included early, late, and overall complications. Pooled odds ratios (ORs) with 95% CIs were obtained through meta-analysis.
Our meta-analysis, which included 6 studies comparing 241 breasts with prior augmentation and 1441 without, demonstrated no significant difference between the 2 groups in rates of early (36.7% vs 24.8%: OR, 1.57; 95% CI, 0.94-2.64; P = 0.09), late (10.1% vs 19.9%: OR, 0.53; 95% CI, 0.06-4.89; P = 0.57), and overall complications (36.5% vs 31.2%: OR, 1.23; 95% CI, 0.76-2.00; P = 0.40). Subgroup analysis showed a significantly higher rate of hematoma formation in the augmented group (3.39% vs 2.15%: OR, 2.68; 95% CI, 1.00-7.16; P = 0.05), but no difference in rates of seroma, infection, mastectomy skin flap necrosis, and prosthesis loss.
Our meta-analysis suggests that prior augmentation does not significantly increase overall postoperative complications in women undergoing skin- or nipple-sparing mastectomy and immediate prosthetic reconstruction. However, the significantly higher rate of hematoma formation in augmented patients warrants further investigation and preoperative discussion.
关于接受过乳房增大术的患者行乳房切除术和即刻假体重建的并发症情况，目前文献中仅有有限的证据。
本系统回顾和荟萃分析的目的是比较有/无既往隆乳史的患者行保留皮肤或乳头的乳房切除术和即刻假体重建后的术后并发症。
于 2020 年 2 月进行系统检索，以查找比较有/无既往隆乳史的患者行保留皮肤或乳头的乳房切除术和即刻假体重建并记录术后并发症的研究。分析的结局包括早期、晚期和总体并发症。通过荟萃分析获得汇总优势比（OR）及其 95%置信区间（CI）。
我们的荟萃分析纳入了 6 项研究，共比较了 241 例有既往隆乳史的乳房和 1441 例无既往隆乳史的乳房，结果显示两组间早期（36.7% vs 24.8%：OR，1.57；95%CI，0.94-2.64；P = 0.09）、晚期（10.1% vs 19.9%：OR，0.53；95%CI，0.06-4.89；P = 0.57）和总体并发症（36.5% vs 31.2%：OR，1.23；95%CI，0.76-2.00；P = 0.40）发生率无显著差异。亚组分析显示，既往隆乳组的血肿形成发生率显著更高（3.39% vs 2.15%：OR，2.68；95%CI，1.00-7.16；P = 0.05），但血清肿、感染、乳房皮瓣坏死和假体丢失的发生率无差异。
我们的荟萃分析表明，在接受保留皮肤或乳头的乳房切除术和即刻假体重建的女性中，既往隆乳术并不会显著增加总体术后并发症。然而，既往隆乳组血肿形成发生率显著更高，这需要进一步研究和术前讨论。
