Smith J Michael, Boukovalas Stefanos, Chang Edward I, Liu Jun, Selber Jesse C, Hanson Summer E, Reece Gregory P
Division of Plastic Surgery, The University of Texas Medical Branch, Galveston, Tex.
Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex.
Plast Reconstr Surg Glob Open. 2023 Mar 8;11(3):e4861. doi: 10.1097/GOX.0000000000004861. eCollection 2023 Mar.
Although autologous free-flap breast reconstruction is the most durable means of reconstruction, it is unclear how many additional operations are needed to optimize the aesthetic outcome of the reconstructed breast. The present study aimed to determine the average number of elective breast revision procedures performed for aesthetic reasons in patients undergoing unilateral autologous breast reconstruction and to analyze variables associated with undergoing additional procedures.
A retrospective review of all unilateral abdominal-based free-flap breast reconstructions performed from 2000 to 2014 was undertaken at a tertiary academic center.
Overall, 1251 patients were included in the analysis. The average number of breast revision procedures was 1.1 ± 0.9, and 903 patients (72.2%) underwent at least one revision procedure. Multiple logistic regression analysis demonstrated that younger age, higher body mass index, and prior oncologic surgery on the reconstructed breast were factors associated with increased likelihood of undergoing a revision procedure. The probability of undergoing at least one revision increased by 4% with every 1-unit (kg/m) increase in a patient's body mass index. Multiple Poisson regression modeling demonstrated that younger age, prior oncologic surgery on the reconstructed breast, and bipedicle flap reconstruction were significant factors associated with undergoing a greater number of revision procedures.
Most patients who undergo unilateral autologous breast reconstruction require at least one additional operation to optimize their breast aesthetic results. Young age and obesity increase the likelihood of undergoing additional operations. These findings can aid reconstructive microsurgeons in counseling patients and establishing patient expectations prior to their undergoing microvascular breast reconstruction.
尽管自体游离皮瓣乳房重建是最持久的重建方式，但尚不清楚需要进行多少次额外手术才能优化重建乳房的美学效果。本研究旨在确定接受单侧自体乳房重建的患者因美学原因进行的选择性乳房修复手术的平均次数，并分析与接受额外手术相关的变量。
在一家三级学术中心对2000年至2014年期间进行的所有单侧腹部游离皮瓣乳房重建进行回顾性研究。
总体而言，1251例患者纳入分析。乳房修复手术的平均次数为1.1±0.9次，903例患者（72.2%）接受了至少一次修复手术。多因素逻辑回归分析表明，年龄较小、体重指数较高以及重建乳房先前接受过肿瘤手术是与接受修复手术可能性增加相关的因素。患者体重指数每增加1个单位（kg/m²），接受至少一次修复的概率增加4%。多因素泊松回归模型表明，年龄较小、重建乳房先前接受过肿瘤手术以及双蒂皮瓣重建是与接受更多修复手术相关的重要因素。
大多数接受单侧自体乳房重建的患者需要至少一次额外手术来优化乳房美学效果。年轻和肥胖会增加接受额外手术的可能性。这些发现有助于重建显微外科医生在患者接受微血管乳房重建之前为其提供咨询并建立患者期望。
