DeWitt Daughtry Family Department of Surgery, University of Miami School of Medicine, Miami, FL.
DeWitt Daughtry Family Department of Surgery, University of Miami School of Medicine, Miami, FL.
Clin Breast Cancer. 2022 Feb;22(2):136-142. doi: 10.1016/j.clbc.2021.07.016. Epub 2021 Aug 5.
Skin-sparing (SSM) and nipple-sparing mastectomy (NSM) with immediate breast reconstruction (IBR) have significantly increased. There is limited information on complications of IBR in patients with prior cosmetic breast surgery (CBS). We compare IBR outcomes in patients undergoing SSM and/or NSM with and without prior CBS.
Patients undergoing mastectomy from January 1, 2017 to December 31, 2019 were selected. Patient characteristics, surgical approach, and complications were compared between mastectomy and IBR cases for breasts with and without prior CBS. Binary logistic regression analysis was performed to identify predictors of complications and reconstruction loss.
956 mastectomies were performed in 697 patients, with IBR performed for 545 mastectomies in 356 patients. Median age was 51 (range 19-83), 45.8% of patients were age < 50, 62.6% of mastectomies were performed for breast cancer. 95 mastectomies (17.4%) were performed in breasts with prior CBS and 450 (82.6%) without. NSM was more frequently utilized for breasts with prior CBS (P < .001). Complications occurred in 80 mastectomies (14.7%); reconstruction loss in 30 (5.5%). On multivariable analysis, age ≥ 50 (OR 1.76, 95%CI 1.01-3.09, P = .047) and NSM (OR 2.11, 95%CI 1.17-3.79, P = .013) were associated with an increased risk of any complication. Prior CBS was not associated with an increased risk of complications (OR 1.11, 95%CI 0.58-2.14, P = .743) or reconstruction loss (OR 1.32, 95%CI 0.51-3.38, P = .567).
In this analysis of mastectomy and IBR, prior CBS was not associated with an increased risk of complications or reconstruction loss. In patients with prior CBS undergoing mastectomy, IBR may be safely performed.
保留皮肤（SSM）和保留乳头（NSM）乳房切除术联合即刻乳房重建（IBR）的应用显著增加。对于既往接受过美容乳房手术（CBS）的患者，IBR 的并发症信息有限。我们比较了 SSM 和/或 NSM 联合和不联合既往 CBS 患者的 IBR 结果。
选择 2017 年 1 月 1 日至 2019 年 12 月 31 日期间行乳房切除术的患者。比较了既往 CBS 乳房与无 CBS 乳房的乳房切除术和 IBR 病例的患者特征、手术方法和并发症。采用二项逻辑回归分析识别并发症和重建失败的预测因素。
697 例患者中共有 956 例接受了乳房切除术，其中 356 例患者共进行了 545 例 IBR。中位年龄为 51 岁（范围 19-83 岁），45.8%的患者年龄＜50 岁，62.6%的乳房切除术是为了治疗乳腺癌。95 例（17.4%）乳房切除术为既往 CBS 乳房，450 例（82.6%）为无 CBS 乳房。既往 CBS 乳房更常采用 NSM（P＜0.001）。80 例乳房切除术（14.7%）发生并发症，30 例（5.5%）重建失败。多变量分析显示，年龄≥50 岁（OR 1.76，95%CI 1.01-3.09，P=0.047）和 NSM（OR 2.11，95%CI 1.17-3.79，P=0.013）与任何并发症的风险增加相关。既往 CBS 与并发症风险增加无关（OR 1.11，95%CI 0.58-2.14，P=0.743）或重建失败风险增加无关（OR 1.32，95%CI 0.51-3.38，P=0.567）。
在这项乳房切除术和 IBR 分析中，既往 CBS 与并发症或重建失败的风险增加无关。对于既往 CBS 患者，行乳房切除术时可安全地进行 IBR。
