Hassan Abbas M, Tran Jacquelynn, Asaad Malke, Slovacek Cedar, Liu Jun, Butler Charles E
From the Department of Plastic and Reconstructive Surgery, University of Texas M. D. Anderson Cancer Center.
Department of Plastic and Reconstructive Surgery, University of Texas Medical Branch.
Plast Reconstr Surg. 2023 Mar 1;151(3):367e-375e. doi: 10.1097/PRS.0000000000009903. Epub 2022 Nov 19.
Implant-based reconstruction (IBR) is the most common method of breast reconstruction in the United States. Despite ongoing advancements, periprosthetic infection is a serious problem that often results in device explantation. The objective of this study was to evaluate the outcomes of third-attempt reconstruction in patients in whom secondary implant-based reconstruction failed because of infection.
The authors performed a retrospective review of patients who underwent mastectomy followed by IBR from 2000 to 2019. The outcomes of patients in whom secondary IBR failed because of infection and who ultimately underwent third-attempt breast reconstruction were analyzed.
Of 6093 patients who underwent primary IBR, 13 patients had third-attempt breast reconstruction following infection-related explantation [median age, 52 years (interquartile range, 51 to 56 years); median body mass index, 23 kg/m 2 (interquartile range, 22 to 31 kg/m 2 ); median follow-up, 46 months (interquartile range, 16 to 62 months)]. Nine patients (70%) underwent IBR, two (15%) underwent IBR combined with pedicled latissimus dorsi flap, and two (15%) underwent abdominally based free tissue transfer. Third-attempt breast reconstruction was immediate in 46% of patients and delayed in 54%. The success rate was 78% in the IBR group, with a 23% complication rate. The success rate for autologous breast reconstruction was 100%, with one patient developing venous congestion necessitating return to the operating room.
Third-attempt breast reconstruction following infection-associated failed secondary IBR is a safe and feasible option. Although the risk of failure is higher than that for primary implant-based reconstruction, a third attempt after secondary IBR infection had a surprisingly high 78% success rate.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
基于植入物的乳房重建（IBR）是美国最常见的乳房重建方法。尽管技术不断进步，但假体周围感染仍是一个严重问题，常导致取出植入装置。本研究的目的是评估因感染导致二次基于植入物的乳房重建失败的患者进行第三次重建的结果。
作者对2000年至2019年接受乳房切除术后进行IBR的患者进行了回顾性研究。分析了因感染导致二次IBR失败并最终接受第三次乳房重建的患者的结果。
在6093例接受初次IBR的患者中，13例在因感染取出植入物后进行了第三次乳房重建[中位年龄52岁（四分位间距，51至56岁）；中位体重指数23kg/m²（四分位间距，22至31kg/m²）；中位随访时间46个月（四分位间距，16至62个月）]。9例患者（70%）接受了IBR，2例（15%）接受了IBR联合带蒂背阔肌皮瓣，2例（15%）接受了腹部游离组织移植。46%的患者第三次乳房重建为即刻重建，54%为延迟重建。IBR组的成功率为78%，并发症发生率为23%。自体乳房重建的成功率为100%，1例患者出现静脉淤血，需要返回手术室。
因感染导致二次IBR失败后进行第三次乳房重建是一种安全可行的选择。虽然失败风险高于初次基于植入物的重建，但二次IBR感染后进行第三次尝试的成功率高达78%，令人惊讶。
临床问题/证据级别：风险，III级
