Haran Oriana, Legarda Carolina, Gofstein Dina, Adelson Dana, Singolda Roei, Madah Ehab, Arad Ehud, Grush Andrew E, Barnea Yoav
Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Semin Plast Surg. 2022 Jun 13;36(2):94-100. doi: 10.1055/s-0042-1750435. eCollection 2022 May.
Fat necrosis is a common complication of breast surgery, with the potential to cause both functional and aesthetic repercussions that can affect patient satisfaction. Although several fat necrosis classification systems have been proposed, fat necrosis management varies widely across institutions, requiring revisiting of existing treatment protocols. We evaluated the postoperative outcomes on 335 breasts following either breast reduction or reconstruction with deep inferior epigastric perforator (DIEP) flaps at our institution between 2016 and 2020, with particular attention to the development of fat necrosis and the need for subsequent surgical intervention. Fat necrosis was diagnosed in 36 (10.74%) breasts, of which 16 (44.4%) were surgically removed and 20 (55.5%) were conservatively managed. Time of fat necrosis diagnosis: early (≤one-month after breast surgery) or late (>1 month) was the only variable associated with surgical intervention. Fat necrosis management should be approached on a case-by-case basis. Whenever possible, conservative management with regular clinical and radiological follow-up, and patient reassurance, should be pursued even for large masses, in the absence of concomitant complications.
脂肪坏死是乳腺手术的常见并发症，有可能导致功能和美学方面的不良影响，进而影响患者满意度。尽管已经提出了几种脂肪坏死分类系统，但各机构对脂肪坏死的处理方式差异很大，因此需要重新审视现有的治疗方案。我们评估了2016年至2020年期间在我院接受乳房缩小术或采用腹壁下深动脉穿支（DIEP）皮瓣进行乳房重建的335例乳房的术后结果，特别关注脂肪坏死的发生情况以及后续手术干预的必要性。36例（10.74%）乳房被诊断为脂肪坏死，其中16例（44.4%）接受了手术切除，20例（55.5%）接受了保守治疗。脂肪坏死诊断时间：早期（乳房手术后≤1个月）或晚期（>1个月）是与手术干预相关的唯一变量。脂肪坏死的处理应根据具体情况进行。只要有可能，即使是对于较大的肿块，在没有并发其他并发症的情况下，也应采用定期临床和影像学随访以及安抚患者的保守治疗方法。
