From the College of Medicine, SUNY Upstate Medical University, Syracuse, NY.
Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, CA.
Ann Plast Surg. 2021 May 1;86(5S Suppl 3):S390-S394. doi: 10.1097/SAP.0000000000002762.
Postmastectomy radiation therapy (PMRT) is known to increase the risk of multiple adverse outcomes after breast reconstruction. In the context of delayed-immediate autologous breast reconstruction, PMRT is typically conducted after placement of subpectoral (SP) tissue expanders. With the re-emergence of prepectoral (PP) reconstruction, there are little data assessing the outcomes of PP reconstruction in breasts receiving PMRT. We compared postoperative outcomes of PMRT patients undergoing delayed-immediate, autologous breast reconstruction with placement of tissue expanders in either the PP or SP plane.
A retrospective chart review was conducted on all consecutive patients who underwent delayed-immediate autologous breast reconstruction and received PMRT at either the Stanford University or the Johns Hopkins University Hospitals between January 2009 and December 2018. Demographics, comorbidities, perioperative information, and oncologic data were collected for all patients. Complications were collected and analyzed after stage 1 surgery, between 30 days of stage 1 and up to stage 2 surgery, and after stage 2 surgery. Multivariable regressions were used to determine predictors of 1 or more complications.
A total of 71 patients (73 breasts) were included. Prepectoral reconstruction comprised of 52.2% of the cohort, and the remaining 47.8% were SP reconstructions. Demographics and comorbidities were similar between groups, except for premastectomy radiation, which was more prevalent in the PP cohort (P = 0.010). Complications were similar between cohorts after stage 1 surgery (P = 0.420), between stages 1 and 2 (P = 0.100), and after stage 2 (P = 0.570). There were higher rates of skin necrosis in the SP cohort between stages 1 and 2 (PP: 2.6%, SP: 20%, P = 0.004). Multivariable analysis revealed body mass index to be the only predictor of complication (P = 0.041). The mean number of revisionary surgeries was higher in the SP cohort (PP: 0.8 vs SP: 1.9, P = 0.002). The mean follow-up was 385.5 days and similar between groups (P = 0.870).
Rates of overall complication were similar between PP and SP expander placement. However, in SP reconstructions, skin necrosis was significantly higher between stages 1 and 2. The patients in the SP cohort also underwent a greater number of revisionary surgeries, although overall rates of pursuing any revisionary surgery were similar between groups.
乳房重建后接受辅助放疗（PMRT）已知会增加多种不良后果的风险。在延迟即刻自体乳房重建的背景下，PMRT 通常在胸肌下（SP）组织扩张器放置后进行。随着胸肌前（PP）重建的重新出现，很少有数据评估接受 PMRT 的乳房中 PP 重建的结果。我们比较了在斯坦福大学或约翰霍普金斯大学医院接受延迟即刻自体乳房重建且在 PP 或 SP 平面放置组织扩张器的 PMRT 患者的术后结果。
对 2009 年 1 月至 2018 年 12 月期间在斯坦福大学或约翰霍普金斯大学医院接受延迟即刻自体乳房重建并接受 PMRT 的所有连续患者进行了回顾性图表审查。收集了所有患者的人口统计学、合并症、围手术期信息和肿瘤学数据。在第 1 阶段手术后、第 1 阶段 30 天至第 2 阶段手术之间以及第 2 阶段手术后收集并分析了并发症。使用多变量回归确定 1 个或多个并发症的预测因素。
共纳入 71 例患者（73 例乳房）。PP 重建占队列的 52.2%，其余 47.8%为 SP 重建。两组的人口统计学和合并症相似，除了术前放疗，PP 组更常见（P = 0.010）。第 1 阶段手术后（P = 0.420）、第 1 阶段和第 2 阶段之间（P = 0.100）以及第 2 阶段后（P = 0.570），两组的并发症相似。第 1 阶段和第 2 阶段之间 SP 组皮肤坏死的发生率更高（PP：2.6%，SP：20%，P = 0.004）。多变量分析显示体重指数是并发症的唯一预测因素（P = 0.041）。SP 组的修正手术次数更高（PP：0.8 次与 SP：1.9 次，P = 0.002）。平均随访时间为 385.5 天，两组相似（P = 0.870）。
PP 和 SP 扩张器放置之间的总体并发症发生率相似。然而，在 SP 重建中，第 1 阶段和第 2 阶段之间的皮肤坏死明显更高。SP 组的患者还进行了更多的修正手术，尽管两组之间接受任何修正手术的总体比率相似。
