Michno Viktoria, Malter Wolfram, Paepke Stefan, Thill Marc, Kelling Katharina, Meiré Anette, Tofall Sabrina, Nolte Elke, Christ Hildegard, Eichler Christian
Clinic for Gynecology and Obstetrics, Center of Breast Disease, University of Cologne, Cologne, Germany.
Clinic for Gynecology and Obstetrics, Center of Breast Disease, University of Cologne, Cologne, Germany.
Surg Oncol. 2022 Mar;40:101675. doi: 10.1016/j.suronc.2021.101675. Epub 2021 Nov 16.
Skin/nipple-sparing mastectomies (SSM/NSSM) have been reported to have acceptable complication rates and good aesthetic outcomes with high patient satisfaction. However, in this relatively young and rapidly expanding field of reconstructive plastic surgery, differences in perioperative management are noted between breast centers. Prospective studies of complication rates using a titanized polypropylene mesh (TiLOOP® Bra) are currently lacking.
A prospective subgroup analysis was performed based on the data set of the prospective, single-arm, multicenter observational study (PRO-BRA). Early complication rates after skin/nipple-sparing mastectomy with implant-based immediate or secondary reconstruction using a titanized polypropylene mesh (TiLOOP® Bra) subpectorally were investigated in relation to demographic factors, as well as intra-and postoperative management. The subgroup consists of 258 patients. Complications were categorised into necrosis, infection, postoperative bleeding or hematoma, seroma, wound healing delays and R1-situations.
Early complication rates of SSM/NSSM using titanium-based meshes are comparable to complication-rates using ADM's. Logistic regression shows significantly higher risk for wound healing delays, necrosis and seroma with increasing BMI, abladat- and implant-weight (OR 1,17 -1,66, p-value < 0,001). Smokers have significantly higher necrosis rates (20.7%) compared to non-smokers (5.5%) (p-value = 0.002). Discharge with drainage results in a trend toward higher rates of wound healing complications.
The use of TiLOOP® Bra meshes was shown to have acceptable complication rates. Complication rates depend on certain demographic and intraoperative risk factors and should be considered in indications and information of patients.
据报道，保乳/保乳头乳房切除术（SSM/NSSM）的并发症发生率可接受，美学效果良好，患者满意度高。然而，在这个相对年轻且迅速发展的整形重建外科领域，各乳腺中心在围手术期管理方面存在差异。目前缺乏使用钛化聚丙烯网片（TiLOOP® Bra）的并发症发生率的前瞻性研究。
基于前瞻性单臂多中心观察性研究（PRO - BRA）的数据集进行前瞻性亚组分析。研究了采用钛化聚丙烯网片（TiLOOP® Bra）在胸大肌下进行保乳/保乳头乳房切除术后即刻或二期植入重建后的早期并发症发生率与人口统计学因素以及术中和术后管理的关系。该亚组由258名患者组成。并发症分为坏死、感染、术后出血或血肿、血清肿、伤口愈合延迟和R1情况。
使用钛基网片的SSM/NSSM早期并发症发生率与使用人工真皮的并发症发生率相当。逻辑回归显示，随着体重指数、切除组织量和植入物重量增加，伤口愈合延迟、坏死和血清肿的风险显著更高（比值比1.17 - 1.66，p值<0.001）。吸烟者的坏死率（20.7%）显著高于非吸烟者（5.5%）（p值 = 0.002）。带引流管出院会导致伤口愈合并发症发生率有升高趋势。
使用TiLOOP® Bra网片显示出可接受的并发症发生率。并发症发生率取决于某些人口统计学和术中风险因素，在患者的适应症评估和告知中应予以考虑。
