From the Department of Plastic and Reconstructive Surgery, The University of Texas M. D. Anderson Cancer Center, and The University of Texas, McGovern Medical School.
Plast Reconstr Surg. 2022 Aug 1;150(2):247e-259e. doi: 10.1097/PRS.0000000000009289. Epub 2022 Jun 3.
Infection is a dreaded complication of implant-based breast reconstruction. There is a paucity of literature on the outcomes of a secondary reconstruction after infected implant-based breast reconstruction explantation.
The authors conducted a retrospective study of patients who underwent a second implant-based breast reconstruction following a failed infected device between January of 2006 and December of 2019. Surgical and patient-reported outcomes (BREAST-Q) were collected and analyzed.
A total of 6093 implant-based breast reconstructions were performed during the study period, 298 (5 percent) of which involved device removal because of infection. Eighty-three patients ultimately received 92 second-attempt breast implants. Thirty-six percent of cases developed at least one postoperative complication, with infection [23 breasts (25 percent)] being the most common. Compared with first-attempt implant-based breast reconstruction, we found significantly higher infection rates among second-attempt cases (9 percent and 21 percent, respectively; p = 0.0008). Patient-reported satisfaction with the breast and sexual well-being were lower after second-attempt than after first-attempt implant-based breast reconstruction ( p = 0.018 and p = 0.002, respectively) reported in the literature. Mean follow-up was 41 ± 35 months. If we exclude patients with prior radiation therapy and those who received device exchange, the success rate is 88 percent.
It is reasonable to offer women second-attempt implant-based breast reconstruction after explantation because of infection. However, this patient population has a higher infection and explantation rate and lower patient-reported satisfaction than patients undergoing first-attempt implant-based breast reconstruction. Because of these increased surgical risks and elevated complication rates, patients must be given reasonable expectations during preoperative discussions and when providing informed consent for second-attempt implant-based breast reconstruction.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
感染是植入物乳房重建后令人担忧的并发症。关于感染性植入物乳房重建后乳房假体取出后的二次重建结局的文献很少。
作者对 2006 年 1 月至 2019 年 12 月期间因感染性装置失败而接受二次植入物乳房重建的患者进行了回顾性研究。收集并分析了手术和患者报告的结果（BREAST-Q）。
在研究期间共进行了 6093 例植入物乳房重建，其中 298 例（5%）因感染而移除装置。最终有 83 例患者接受了 92 例二次尝试的乳房植入物。36%的病例出现至少一种术后并发症，其中感染（23 例乳房，25%）最为常见。与初次尝试的植入物乳房重建相比，我们发现第二次尝试的病例感染率明显更高（分别为 9%和 21%；p=0.0008）。与初次尝试的植入物乳房重建相比，第二次尝试后患者对乳房和性健康的满意度较低（p=0.018 和 p=0.002）。平均随访时间为 41±35 个月。如果排除先前接受过放疗的患者和接受过器械更换的患者，成功率为 88%。
对因感染而取出乳房假体的女性进行二次尝试植入物乳房重建是合理的。然而，与初次尝试植入物乳房重建的患者相比，该患者人群的感染和假体取出率较低，患者报告的满意度较低。由于这些增加的手术风险和更高的并发症发生率，在术前讨论和提供二次尝试植入物乳房重建的知情同意时，必须让患者有合理的期望。
临床问题/证据水平：风险，III。
