Escandón Joseph M, Sweitzer Keith, Christiano Jose G, Gooch Jessica C, Olzinski Ann Therese, Prieto Peter A, Skinner Kristin A, Langstein Howard N, Manrique Oscar J
Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA.
Division of Surgical Oncology, Department of Surgery, Wilmot Cancer Center, University of Rochester Medical Center, NY, USA.
J Plast Reconstr Aesthet Surg. 2023 Jan;76:76-87. doi: 10.1016/j.bjps.2022.10.028. Epub 2022 Oct 19.
Approximately 80% of patients undergoing total mastectomy in the US opt for implant-based breast reconstruction (IBBR). A two-stage reconstruction with tissue expander (TE) remains the most common technique. Since the implementation of ADMs, a prepectoral approach has gained popularity and is becoming the standard of care. Herein, we compared the surgical and postoperative outcomes of prepectoral versus subpectoral two-stage IBBR.
A retrospective chart review was performed between January 2011 and December 2020. We included female patients undergoing immediate two-stage IBBR. The primary outcomes of this study were to compare the 30-day morbidity and the overall rate of complications during the first and second stages of reconstruction, and to compare the time to initiate postmastectomy radiotherapy (PMRT). Propensity score matching was implemented.
After matching, 154 reconstructions were analyzed, 77 in each group. The two matched groups exhibited comparable (p > 0.05) characteristics for all analyzed demographic and intraoperative independent variables. Reconstructions in the prepectoral group had a shortened median time for drain removal (13-days vs. 15-days, p = 0.001). The intraoperative expansion volumes were higher in the prepectoral group (300 ml versus 200 ml, p = 0.025). The 30-day morbidity and first- and second-stage complication rates were not significantly different between groups. The time to start postmastectomy radiation therapy (PMRT) was not significantly different between groups (134-days versus 126.5-days, p = 0.58).
Prepectoral and subpectoral TE placement had comparable complication rates during the first and second stages of IBBR. Timing for TE-to-Implant exchange and initiation of PMRT were comparable between the two approaches.
在美国，约80%接受全乳切除术的患者选择基于植入物的乳房重建（IBBR）。使用组织扩张器（TE）进行的两阶段重建仍然是最常用的技术。自采用ADM以来，胸肌前入路越来越受欢迎，并正在成为标准治疗方法。在此，我们比较了胸肌前与胸肌下两阶段IBBR的手术及术后结果。
对2011年1月至2020年12月期间进行回顾性病历审查。纳入接受即刻两阶段IBBR的女性患者。本研究的主要结果是比较重建第一阶段和第二阶段的30天发病率及总体并发症发生率，并比较开始乳房切除术后放疗（PMRT）的时间。实施倾向评分匹配。
匹配后，分析了154例重建病例，每组77例。两组在所有分析的人口统计学和术中独立变量方面表现出可比（p>0.05）特征。胸肌前组重建的引流管拔除中位时间缩短（13天对15天，p=0.001）。胸肌前组术中扩张量更高（300ml对200ml，p=0.025）。两组间30天发病率及第一和第二阶段并发症发生率无显著差异。两组开始乳房切除术后放疗（PMRT）的时间无显著差异（134天对126.5天，p=0.58）。
在IBBR的第一阶段和第二阶段，胸肌前和胸肌下TE植入的并发症发生率相当。两种方法在TE更换为植入物的时间及开始PMRT的时间方面相当。
