Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Korea.
Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
Ann Palliat Med. 2021 Mar;10(3):2520-2529. doi: 10.21037/apm-20-1550. Epub 2021 Feb 26.
After skin-sparing mastectomy, direct-to-implant breast reconstruction is divided into a subpectoral and prepectoral techniques. However, there is still lack of studies that have compared the functional recovery after reconstruction based on the two techniques. Therefore, this study was conducted as a prospective comparison of the functional recovery and quality of life between the two techniques.
Patients who had undergone mastectomy for breast cancer were grouped based on whether the approach during direct-to-implant reconstruction was subpectoral or prepectoral. Functional outcomes were evaluated pre-operatively, 2 weeks, 1, 3, and 6 months post-operation. The evaluation included range of motion of the shoulder, maximal muscle power of the shoulder, pain intensity (measured by the visual analogue scale), disability of the upper extremity (measured by the Disabilities of the Arm, Shoulder and Hand questionnaire), quality of life (measured by the 36-Item Short-Form Health Survey), and mood status [measured by the hospital anxiety and depression scale (HADS)]. Repeated-measures analysis of variance was performed to evaluate changes in functional assessments.
In the subpectoral/prepectoral groups, the average age, body mass index (BMI), preoperative breast volume, and implant volume were 45.5/45.1 years, 22.6/22.7 kg/m2 , 244.5/206.0 cm3 , and 258.6/ 234.8 cm3 , respectively. There were no significant differences in functional assessments between the two groups before the operation. There were significant differences in visual analogue scale, Disabilities of the Arm, Shoulder and Hand (DASH) scores, and time interaction effects between the two groups. In post-hoc analysis, the prepectoral group exhibited lower visual analogue scale and DASH scores than those in the subpectoral group at 2 weeks post-operation.
The prepectoral group showed favorable recovery of pain intensity and disability of the upper arm at the early phase post-operation. Both groups functionally recovered at 6 months post-operation. Therefore, the prepectoral technique can be considered as a useful alternative technique, compared to the classic subpectoral technique.
在保留皮肤的乳房切除术之后，直接向植入物的乳房重建分为胸肌下和胸肌前技术。然而，仍然缺乏基于这两种技术比较重建后功能恢复的研究。因此，本研究旨在前瞻性比较这两种技术的功能恢复和生活质量。
根据直接向植入物重建时的方法是胸肌下还是胸肌前，将接受乳腺癌乳房切除术的患者分组。术前、术后 2 周、1 个月、3 个月和 6 个月评估功能结果。评估包括肩部活动范围、肩部最大肌肉力量、疼痛强度（用视觉模拟量表测量）、上肢残疾（用上肢、肩和手残疾问卷测量）、生活质量（用 36 项简短健康调查问卷测量）和情绪状态（用医院焦虑和抑郁量表（HADS）测量）。采用重复测量方差分析评估功能评估的变化。
在胸肌下/胸肌前组中，平均年龄、体重指数（BMI）、术前乳房体积和植入物体积分别为 45.5/45.1 岁、22.6/22.7kg/m2、244.5/206.0cm3和 258.6/234.8cm3。两组患者术前功能评估无显著性差异。两组间视觉模拟量表、上肢、肩和手残疾问卷（DASH）评分和时间交互效应有显著性差异。在事后分析中，术后 2 周时，胸肌前组的视觉模拟量表和 DASH 评分明显低于胸肌下组。
胸肌前组在术后早期疼痛强度和上臂残疾的恢复较好。两组患者在术后 6 个月时功能均恢复。因此，与经典的胸肌下技术相比，胸肌前技术可以作为一种有用的替代技术。
