Patel Ashraf A, Cemaj Sophie L, Martin Shanique A, Cheesborough Jennifer E, Lee Gordon K, Nazerali Rahim S
College of Medicine, University of Nebraska Medical Center, Omaha, NE.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Stanford, CA.
Ann Plast Surg. 2021 May 1;86(5S Suppl 3):S409-S413. doi: 10.1097/SAP.0000000000002760.
Breast reconstruction in the prepectoral plane has recently fallen into favor. Minimizing the number of revisionary procedures after reconstruction is an important factor in improving patient care, but long-term studies on the effects of prepectoral reconstruction are limited. In this study, we compare the revision rates after delayed-immediate, autologous reconstruction between prepectoral and subpectoral reconstructions.
Postoperative charts for all patients undergoing subpectoral or prepectoral delayed-immediate autologous breast reconstruction were retrospectively reviewed at our single tertiary-care institution between 2009 and 2018. Patient demographics, comorbidities, and oncologic history were recorded. Charts after second stage reconstruction were reviewed for up to eighteen months to determine if revisions were necessary. Data collected included the total number of surgeries performed, the average number of procedures performed during each surgery, and the type of revision that was performed. Statistical tests included the chi squared test, unpaired t-test, and logistic regressions.
Data from 89 patients with 125 breast reconstructions were collected. There was a 41.6% of these that were prepectoral reconstructions (P), and 58.4% were subpectoral reconstructions (S). For both groups, nipple sparing, followed by skin sparing mastectomies were most common. Mastectomy rates were not statistically different. Fewer breasts in the prepectoral cohort required any revisions (P, 21.2% vs S, 47.9%; P = 0.002). The subpectoral cohort had higher rates of soft tissue rearrangement (P, 7.7% vs S, 21.9%, P = 0.032), fat grafting (P, 9.6% vs S, 27.4%; P = 0.014), and nipple reconstruction (P: 5.8% vs 20.5%, P = 0.020). Mean follow-up time was not significantly different between patient groups (P, 290.5 days vs S, 375.0 days, P = 0.142). Subpectoral expander placement was found to be the only variable independently predictive of requiring 1 or more revision (P = 0.034).
Breast reconstruction performed in the prepectoral plane is associated with lower overall rates of revisionary surgery. Rates of soft tissue rearrangement, fat grafting, and nipple reconstruction after autologous reconstruction trended higher in subpectoral reconstructions.
胸前区乳房重建近来受到青睐。尽量减少重建后的修复手术数量是改善患者护理的一个重要因素，但关于胸前区重建效果的长期研究有限。在本研究中，我们比较了胸前区和胸肌下延迟即刻自体乳房重建后的修复率。
对2009年至2018年期间在我们单一的三级医疗机构接受胸肌下或胸前区延迟即刻自体乳房重建的所有患者的术后病历进行回顾性分析。记录患者的人口统计学资料、合并症和肿瘤病史。对二期重建后的病历进行长达18个月的复查，以确定是否需要修复。收集的数据包括手术总次数、每次手术的平均操作次数以及进行的修复类型。统计检验包括卡方检验、非配对t检验和逻辑回归。
收集了89例患者125次乳房重建的数据。其中41.6%为胸前区重建（P组），58.4%为胸肌下重建（S组）。两组中，保留乳头，其次是保留皮肤的乳房切除术最为常见。乳房切除率无统计学差异。胸前区队列中需要任何修复的乳房较少（P组为21.2%，S组为47.9%；P = 0.002）。胸肌下队列的软组织重新排列率（P组为7.7%，S组为21.9%，P = 0.032）、脂肪移植率（P组为9.6%，S组为27.4%；P = 0.014）和乳头重建率（P组为5.8%，S组为20.5%，P = 0.020）较高。患者组之间的平均随访时间无显著差异（P组为290.5天，S组为375.0天，P = 0.142）。发现胸肌下扩张器置入是唯一独立预测需要1次或更多次修复的变量（P = 0.034）。
胸前区乳房重建与较低的总体修复手术率相关。自体重建后，胸肌下重建的软组织重新排列、脂肪移植和乳头重建率呈上升趋势。
