Ching Ann Hui, Lim Kimberley, Sze Pek Wan, Ooi Adrian
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore.
J Plast Reconstr Aesthet Surg. 2022 Aug;75(8):2550-2560. doi: 10.1016/j.bjps.2022.02.019. Epub 2022 Feb 24.
Prepectoral implant-based breast reconstruction (PIBR) has regained popularity, despite decades-long preference for subpectoral implant placement. This paper aims to compare patient-reported outcomes (PRO) between prepectoral and subpectoral approaches to implant-based breast reconstruction (IBBR). The primary PRO was with the BREAST-Q, and postoperative pain scores, while the secondary outcomes were complication rates.
A comprehensive literature search of the PubMed library was performed. All studies on patients undergoing IBBR after mastectomy that compared prepectoral to subpectoral placement and PROM or postoperative pain were included.
A total of 3789 unique studies of which 7 publications with 216 and 332 patients who received prepectoral and subpectoral implants, respectively, were included for meta-analysis. Patients with prepectoral implant placement had significantly higher satisfaction with the outcome (p = 0.03) and psychosocial well-being (p = 0.03) module scores. The pain was lower in patients with prepectoral implants on postoperative day 1 (p<0.01) and day 7 (p<0.01). The subgroup analysis of prepectoral breast implants showed that complete acellular dermal matrix coverage had lower rates of wound dehiscence (p<0.0001), but there were no significant differences in complications between one-stage and two-stage procedures.
Overall, patients with prepectoral implants reported higher BREAST-Q scores and lower postoperative pain and lower complications rates than patients with subpectoral implants. In appropriately selected patients, prepectoral implant placement with ADM coverage, be it the primary placement of an implant or placement of a tissue expander before definitive implant placement, should be the modality of choice in patients who choose IBBR. Further research should focus on patient selection, strategies to reduce cost and cost-benefit analysis of PIBR.
尽管数十年来一直倾向于将乳房植入物置于胸大肌下，但基于胸肌前植入物的乳房重建术（PIBR）再度受到欢迎。本文旨在比较基于植入物的乳房重建术（IBBR）中胸肌前和胸肌下两种植入方法的患者报告结局（PRO）。主要的PRO指标采用BREAST-Q和术后疼痛评分，次要结局为并发症发生率。
对PubMed数据库进行全面的文献检索。纳入所有比较乳房切除术后接受IBBR且植入物置于胸肌前与胸肌下的患者以及患者报告结局测量或术后疼痛的研究。
总共3789项独立研究，其中7篇出版物纳入了荟萃分析，分别有216例和332例接受胸肌前和胸肌下植入物的患者。胸肌前植入物放置的患者对结局（p = 0.03）和心理社会幸福感（p = 0.03）模块评分的满意度显著更高。胸肌前植入物患者在术后第1天（p<0.01）和第7天（p<0.01）的疼痛较轻。胸肌前乳房植入物的亚组分析表明，完全无细胞真皮基质覆盖的伤口裂开率较低（p<0.0001），但一期和二期手术之间的并发症无显著差异。
总体而言，与胸肌下植入物的患者相比，胸肌前植入物的患者报告的BREAST-Q评分更高，术后疼痛更低，并发症发生率更低。在适当选择的患者中，采用ADM覆盖的胸肌前植入物放置，无论是植入物的初次放置还是在最终植入物放置前放置组织扩张器，都应是选择IBBR患者的首选方式。进一步的研究应侧重于患者选择、降低成本的策略以及PIBR的成本效益分析。
