From the Azienda Ospedaliera Universitaria Senese, UOC Chirurgia Oncologica della Mammella; Sapienza University of Rome, Policlinico Umberto I, Department of Surgery "P. Valdoni," Unit of Plastic and Reconstructive Surgery; Unità di Oncologia Chirurgica Ricostruttiva della Mammella, "Spedali Riuniti" di Livorno, "Breast Unit" Integrata di Livorno Cecina, Piombino Elba; Department of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese; Plastic and Reconstructive Surgery Unit, San Giovanni-Addolorata Hospital; and the Department of Plastic Surgery, University of Catanzaro Hospital.
Plast Reconstr Surg. 2021 Jun 1;147(6):1278-1286. doi: 10.1097/PRS.0000000000008120.
Implant-based reconstruction is the most performed breast reconstruction, and both subpectoral and prepectoral approaches can lead to excellent results. Choosing the best procedure requires a thorough understanding of every single technique, and proper patient selection is critical to achieve surgical success, in particular when dealing with prepectoral breast reconstruction.
Between January of 2014 and December of 2018, patients undergoing mastectomy and eligible for immediate prepectoral breast reconstruction with tissue expander or definitive implant, were selected. The Prepectoral Breast Reconstruction Assessment score was applied to evaluate patient-related preoperative and intraoperative risk factors that could influence the success of prepectoral breast reconstruction. All patients were scored retrospectively, and the results obtained through this assessment tool were compared to the records of the surgical procedures actually performed.
Three hundred fifty-two patients were included; 112 of them underwent direct-to-implant immediate reconstruction, and 240 underwent the two-stage procedure with temporary tissue expander. According to the Prepectoral Breast Reconstruction Assessment score, direct-to-implant reconstruction should have been performed 6.2 percent times less, leading to an increase of 1.4 percent in two-stage reconstruction and 4.8 percent in submuscular implant placement.
To date, there is no validated system to guide surgeons in identifying the ideal patient for subcutaneous or retropectoral breast reconstruction and eventually whether she is a good candidate for direct-to-implant or two-stage reconstruction. The authors processed a simple risk-assessment score to objectively evaluate the patient's risk factors, to standardize the decision-making process, and to identify the safest and most reliable breast reconstructive procedure.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
基于植入物的重建是最常进行的乳房重建，胸肌下和胸肌前入路都可以获得良好的效果。选择最佳的手术方法需要充分了解每一种技术，并且正确的患者选择对于获得手术成功至关重要，尤其是在进行胸肌前乳房重建时。
在 2014 年 1 月至 2018 年 12 月期间，选择接受乳房切除术且有资格立即进行组织扩张器或确定性植入物的胸肌前乳房重建的患者。应用胸肌前乳房重建评估评分来评估可能影响胸肌前乳房重建成功的患者相关术前和术中危险因素。所有患者均进行回顾性评分，并将通过该评估工具获得的结果与实际进行的手术记录进行比较。
共纳入 352 例患者，其中 112 例直接进行了即刻植入物重建，240 例患者进行了两阶段手术，使用临时组织扩张器。根据胸肌前乳房重建评估评分，直接植入重建应该减少 6.2%，导致两阶段重建增加 1.4%，胸肌下植入增加 4.8%。
迄今为止，还没有经过验证的系统可以指导外科医生识别适合皮下或胸肌后乳房重建的理想患者，以及她是否适合直接植入或两阶段重建。作者提出了一种简单的风险评估评分，以客观评估患者的危险因素，规范决策过程，并确定最安全、最可靠的乳房重建方法。
临床问题/证据水平：治疗性，IV 级。
