From the Plastic and Reconstructive Surgery Service.
the Breast Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center.
Plast Reconstr Surg. 2023 Aug 1;152(2):259-269. doi: 10.1097/PRS.0000000000010249. Epub 2023 Feb 1.
Tissue expanders (TEs) are routinely placed as a first step in breast reconstruction for women who require postmastectomy radiation therapy (PMRT). The final reconstruction can then be performed with implants or conversion to autologous tissues. The purpose of this study was to compare patient-reported outcomes and surgical complications in autologous (ABR) versus implant-based breast reconstruction (IBR) patients following TE-PMRT.
The authors performed a propensity score preliminary analysis (1:1 matching, no replacement) in patients undergoing ABR or IBR following TE-PMRT. Matched covariates included age, race/ethnicity, smoking status, body mass index, history of psychiatric diagnosis, and laterality of reconstruction. Outcomes of interest included complications and BREAST-Q scores for Satisfaction with Breasts, Physical Well-Being of the Chest, Sexual Well-Being, and Psychosocial Well-Being domains.
Of 341 patients with TE-PMRT, a total of 106 patients were included in the matched analysis: 53 ABR patients and 53 IBR patients. ABR and IBR did not differ significantly in matched baseline, cancer, and surgical characteristics. ABR patients had higher scores for Satisfaction with Breasts (greater than the four-point minimal clinically important difference) at all postreconstruction time points compared with IBR patients ( P < 0.05). There were no significant postoperative differences in other BREAST-Q domains. The incidence of complications after definitive reconstruction did not differ significantly among cohorts.
In this matched preliminary analysis, patients who underwent ABR following irradiation to a TE demonstrated superior satisfaction with breast scores compared with IBR patients. Higher powered matched studies are needed to improve shared decision-making for patients who require mastectomy and PMRT as part of their treatment.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
组织扩张器（TE）通常作为接受乳腺癌根治术后放疗（PMRT）的女性乳房重建的第一步。最终的重建可以使用植入物或转化为自体组织来完成。本研究的目的是比较 TE-PMRT 后接受自体（ABR）与基于植入物的乳房重建（IBR）患者的患者报告结局和手术并发症。
作者对接受 TE-PMRT 后行 ABR 或 IBR 的患者进行了倾向评分初步分析（1:1 匹配，无替换）。匹配的协变量包括年龄、种族/民族、吸烟状况、体重指数、精神科诊断史和重建的侧别。感兴趣的结局包括并发症和 BREAST-Q 评分，包括乳房满意度、胸部生理健康、性健康和心理社会健康领域。
在 341 例接受 TE-PMRT 的患者中，共有 106 例患者纳入匹配分析：53 例 ABR 患者和 53 例 IBR 患者。ABR 和 IBR 在匹配的基线、癌症和手术特征方面无显著差异。与 IBR 患者相比，ABR 患者在所有重建后时间点的乳房满意度评分更高（大于四分的最小临床重要差异）（P <0.05）。其他 BREAST-Q 领域术后无显著差异。两组患者在确定性重建后并发症的发生率无显著差异。
在这项匹配的初步分析中，接受 TE 照射后行 ABR 的患者与接受 IBR 的患者相比，乳房满意度评分更高。需要进行更高功率的匹配研究，以改善需要接受乳房切除术和 PMRT 作为其治疗一部分的患者的共同决策。
临床问题/证据水平：治疗性，III 级。
