Department of General Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina.
Department of Plastic and Reconstructive Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina.
J Reconstr Microsurg. 2021 Nov;37(9):720-727. doi: 10.1055/s-0041-1726031. Epub 2021 Mar 31.
Breast mound and nipple creation are the goals of the reconstructive process. Unlike in normal body mass index (BMI) women, breast reconstruction in the obese is associated with increased risk of perioperative complications. Our aim was to determine if reconstruction technique and the incidence of perioperative complications affect the achievement of reconstruction completion in the obese female.
Consecutive obese women (BMI ≥30) who underwent mastectomy and implant or autologous reconstruction were evaluated for the completion of breast reconstruction.
Two hundred twenty-five women with 352 reconstructions were included. Seventy-four women underwent 111 autologous reconstructions and 151 women underwent 241 implant-based reconstructions. Chemotherapy, radiation, and delayed reconstruction timing was more common in the autologous patients. Major perioperative complications (requiring hospital readmission or unplanned surgery) occurred more frequently in the implant group ( ≤ 0.0001). Breast mounds were completed in >98% of autologous cases compared with 76% of implant cases ( ≤ 0.001). Nipple areolar complex (NAC) creation was completed in 57% of autologous patients and 33% of implant patients ( = 0.0009). The rate of successfully completing the breast mound and the NAC was higher in the autologous patient group (Mound odds ratio or OR 3.32, 95% confidence interval or CI 1.36-5.28 and NAC OR 2.7, 95% CI 1.50-4.69).
Occurrence of a major complication in the implant group decreased the rate of reconstruction completion. Obese women who undergo autologous breast reconstruction are more likely to achieve breast reconstruction completion when compared with obese women who undergo implant-based breast reconstruction.
乳房重建的目标是重建乳房丘和乳头。与正常体重指数（BMI）女性不同，肥胖女性的乳房重建与围手术期并发症风险增加有关。我们的目的是确定重建技术和围手术期并发症的发生率是否会影响肥胖女性乳房重建的完成。
连续评估接受乳房切除术和植入物或自体重建的肥胖女性（BMI≥30），以确定乳房重建的完成情况。
共纳入 225 例女性，共 352 例重建。74 例女性接受了 111 例自体重建，151 例女性接受了 241 例植入物重建。在自体患者中，化疗、放疗和延迟重建时间更为常见。在植入物组中，更常发生主要围手术期并发症（需要住院再入院或计划外手术）（≤0.0001）。自体病例中乳房丘完成率超过 98%，而植入病例中完成率为 76%（≤0.001）。57%的自体患者和 33%的植入患者完成了乳头乳晕复合体（NAC）的再造（=0.0009）。自体患者组完成乳房丘和 NAC 的比率较高（丘 OR 3.32，95%CI 1.36-5.28，NAC OR 2.7，95%CI 1.50-4.69）。
植入物组发生重大并发症会降低重建完成率。与接受植入物乳房重建的肥胖女性相比，接受自体乳房重建的肥胖女性更有可能完成乳房重建。
