Long Chao, Kraenzlin Franca, Aravind Pathik, Kokosis George, Yesantharao Pooja, Sacks Justin M, Rosson Gedge D
Department of Plastic and Reconstructive Surgery, Johns Hopkins University, 601N Caroline St, Baltimore, MD, United States.
Department of Plastic and Reconstructive Surgery, Johns Hopkins University, 601N Caroline St, Baltimore, MD, United States.
J Plast Reconstr Aesthet Surg. 2022 Sep;75(9):3041-3047. doi: 10.1016/j.bjps.2022.04.030. Epub 2022 Apr 26.
Many breast reconstruction patients undergo post-mastectomy radiation therapy (PMRT), which is well known to increase the risk of complications. There is limited data on outcomes and safety of prepectoral breast reconstruction in this setting. The purpose of this study was to compare the outcomes of prepectoral versus subpectoral two-stage breast reconstruction in patients undergoing PMRT.
We conducted a retrospective cohort study of two-stage breast reconstructions performed at our institution during a 22-month period. Patients who received PMRT were identified, and two cohorts were created: those who underwent prepectoral versus subpectoral reconstruction. We collected data including patient characteristics, operative variables, and clinical outcomes. Bivariate analyses and multivariable logistic regressions were conducted.
We captured 313 patients (492 breasts) that had undergone two-stage reconstruction. A total of 69 breasts received PMRT; 28 were reconstructed prepectorally, and 41 breasts subpectorally. The two cohorts were well matched. We detected no differences in clinical outcomes between the two groups after a median follow-up time of 24 months. There, however, were differences in perioperative variables. Prepectoral reconstruction was associated with a shorter operative time, shorter length of hospital stay, higher cost, and shorter time to final reconstruction. Multivariable logistic regression demonstrated that prepectoral reconstruction is not an independent predictor of adverse events.
Although radiation is a known risk factor for many complications following breast reconstruction, prepectoral device placement is safe in this high-risk population. Although the rate of capsular contracture is reported to be higher in the general prepectoral population, this was not found in our radiated prepectoral population.
许多乳房重建患者在乳房切除术后接受放射治疗（PMRT），众所周知，这会增加并发症的风险。在这种情况下，关于胸前区乳房重建的结果和安全性的数据有限。本研究的目的是比较接受PMRT的患者进行胸前区与胸肌下两阶段乳房重建的结果。
我们对在22个月期间在我们机构进行的两阶段乳房重建进行了一项回顾性队列研究。确定接受PMRT的患者，并创建两个队列：接受胸前区重建与胸肌下重建的患者。我们收集了包括患者特征、手术变量和临床结果的数据。进行了双变量分析和多变量逻辑回归。
我们纳入了313例接受两阶段重建的患者（492个乳房）。共有69个乳房接受了PMRT；28个进行了胸前区重建，41个进行了胸肌下重建。两个队列匹配良好。在中位随访时间24个月后，我们未发现两组临床结果存在差异。然而，围手术期变量存在差异。胸前区重建与手术时间较短、住院时间较短、费用较高以及最终重建时间较短相关。多变量逻辑回归表明，胸前区重建不是不良事件的独立预测因素。
尽管放射是乳房重建后许多并发症的已知危险因素，但在这个高风险人群中进行胸前区植入物放置是安全的。虽然据报道在一般胸前区人群中包膜挛缩率较高，但在我们接受放射治疗的胸前区人群中未发现这种情况。
