Baker Nusaiba F, Brown Ciara A, Styblo Toncred M, Carlson Grant W, Losken Albert
Emory Division of Plastic and Reconstructive Surgery, Atlanta, Ga.
Emory Winship Division of Surgical Oncology, Atlanta, Ga.
Plast Reconstr Surg Glob Open. 2022 Mar 2;10(3):e4151. doi: 10.1097/GOX.0000000000004151. eCollection 2022 Mar.
Patients occasionally need completion mastectomy (CM) following oncoplastic reduction for various reasons necessitating definitive reconstructive techniques. The purpose of this study was to evaluate those patients who required CM following oncoplastic reduction and evaluate indications, technique, and outcomes.
Patients who underwent a completion mastectomy at some time point following the oncoplastic reduction were identified. Factors that influenced CM and additional reconstruction were analyzed. All statistical analysis was conducted using the IBM SPSS Statistics 27.0 (IBM Corp.).
A total of 29 patients (5.3%) underwent CM during the study period with an average follow-up of 3 years since the original procedure. The most common reasons were positive margins (20/29, 69.0%) and recurrence (8/29, 27.6%). Twenty-two had reconstructive procedures (75.9%) and seven did not (24.1%). The patients who underwent CM and reconstruction were significantly younger (49.2 years) than those who had no reconstruction (64.3 years, = 0.004). The most common type of reconstruction was transverse rectus abdominis myocutaneous (TRAM)/deep inferior epigastric perforator (DIEP) flap (12/22, 54.5%), followed by latissimus (6/22, 27.3%) and tissue expander (3/22, 13.6%). The complication rate in the CM group was 24% (N = 7/29), which included two seromas (6.9%), followed by infection, fat necrosis, mastectomy skin necrosis, and donor site necrosis (3.4% each).
Completion mastectomy is indicated typically for positive margins or recurrence. Reconstruction is performed more frequently in younger patients, with the TRAM/DIEP flap and latissimus dorsi reconstruction being the most common technique.
由于各种需要确定性重建技术的原因，患者在肿瘤整形缩小术后偶尔需要进行乳房切除修复术（CM）。本研究的目的是评估那些在肿瘤整形缩小术后需要CM的患者，并评估其适应症、技术和结果。
确定在肿瘤整形缩小术后某个时间点接受乳房切除修复术的患者。分析影响CM和额外重建的因素。所有统计分析均使用IBM SPSS Statistics 27.0（IBM公司）进行。
在研究期间，共有29名患者（5.3%）接受了CM，自最初手术以来的平均随访时间为3年。最常见的原因是切缘阳性（20/29，69.0%）和复发（8/29，27.6%）。22名患者进行了重建手术（75.9%），7名患者未进行（24.1%）。接受CM和重建的患者明显比未进行重建的患者年轻（49.2岁对64.3岁，P = 0.004）。最常见的重建类型是腹直肌肌皮瓣（TRAM）/腹壁下深动脉穿支皮瓣（DIEP）（12/22，54.5%），其次是背阔肌瓣（6/22，27.3%）和组织扩张器（3/22，13.6%）。CM组的并发症发生率为24%（N = 7/29），其中包括2例血清肿（6.9%），其次是感染、脂肪坏死、乳房切除皮肤坏死和供区坏死（各3.4%）。
乳房切除修复术通常适用于切缘阳性或复发的情况。年轻患者更常进行重建，TRAM/DIEP皮瓣和背阔肌重建是最常见的技术。
