Breast Surgery, Breast Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, University of Florence, L.go Brambilla 3, 50134, Florence, Italy.
Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy.
Breast Cancer. 2022 Mar;29(2):302-313. doi: 10.1007/s12282-021-01314-0. Epub 2021 Nov 14.
We re-evaluated acute and early-late toxicity-related factors among pre-pectoral immediate tissue expander/implant (TE/I) breast reconstruction (BR) unselected, first-era, cases, including previous breast radiation treatment and post-mastectomy radiation therapy (PMRT). A retrospective analysis of 146 (117 therapeutic and 29 prophylactic) pre-pectoral reconstructions, between 2012 and 2016, considered patient-related (age, body mass index [BMI], smoke-history, comorbidity, BRCA mutation), and treatment-related characteristics (previous irradiation, axillary surgery, PMRT, pre- and postoperative chemotherapy, endocrine therapy, and target-therapy). Safety was evaluated as acute and early-late complications, and TE/I failures. At multivariate analysis of the 146 cases (117 patients submitted to BR) a significant factor related to acute toxicity was: BMI ≥ 25 (31.3% [≥ 25] vs 8.8% [< 25]; OR 4.44, 95% CI 1.56-12.6; p = 0.003), while previous breast surgery on ipsilateral side presented a borderline significance (31.6% [previous surgery] vs 7.4% [no previous surgery]; OR 3.74, 95% CI 0.97-14.40; p = 0.055). Factors significantly related to TE/I failure were: current or previous smoking exposition (13.8% [smokers] vs 2.6% [non-smokers]; OR 7.32, 95% CI 1.37-39.08; p = 0.02) and preoperative chemotherapy (18.8% [yes] vs 3.5% [no]; OR 8.16, 95% CI 1.29-51.63; p = 0.026). At 4-year median follow-up, 3 deaths, 5 locoregional recurrences, and 14 distant metastases occurred. Immediate pre-pectoral BR is safe and effective, with low rates of acute and early-late complications. BMI and previous breast surgery were related to higher complications but not failure; smoking and preoperative chemotherapy were related to TE/I explant. Previous RT and PMRT were related neither to early-late toxicity nor failure.
我们重新评估了未选择前胸部即刻组织扩张器/植入物（TE/I）乳房重建（BR）的急性和早期晚期毒性相关因素，包括以前的乳房放疗和乳房切除术后放疗（PMRT）。回顾性分析了 2012 年至 2016 年间 146 例（117 例治疗性和 29 例预防性）前胸部重建患者的患者相关（年龄、体重指数[BMI]、吸烟史、合并症、BRCA 突变）和治疗相关特征（以前的照射、腋窝手术、PMRT、术前和术后化疗、内分泌治疗和靶向治疗）。安全性评估为急性和早期晚期并发症以及 TE/I 失败。在对 146 例病例（117 例接受 BR 的患者）的多变量分析中，与急性毒性相关的显著因素是：BMI≥25（31.3%[≥25]与 8.8%[<25]；OR 4.44，95%CI 1.56-12.6；p=0.003），而同侧以前的乳房手术呈边缘显著（31.6%[以前的手术]与 7.4%[无以前的手术]；OR 3.74，95%CI 0.97-14.40；p=0.055）。与 TE/I 失败显著相关的因素是：当前或以前的吸烟暴露（13.8%[吸烟者]与 2.6%[非吸烟者]；OR 7.32，95%CI 1.37-39.08；p=0.02）和术前化疗（18.8%[是]与 3.5%[否]；OR 8.16，95%CI 1.29-51.63；p=0.026）。在中位随访 4 年时，发生 3 例死亡、5 例局部区域复发和 14 例远处转移。即刻前胸部 BR 安全有效，急性和早期晚期并发症发生率低。BMI 和以前的乳房手术与更高的并发症相关，但与失败无关；吸烟和术前化疗与 TE/I 取出相关。以前的 RT 和 PMRT 与早期晚期毒性或失败均无关。
