From the Departments of Plastic and Reconstructive Surgery.
University of Texas McGovern Medical School.
Plast Reconstr Surg. 2024 Jan 1;153(1):24-33. doi: 10.1097/PRS.0000000000010489. Epub 2023 Apr 4.
Postmastectomy radiotherapy (PMRT) is associated with altered cosmetic outcomes and higher complication rates in implant-based breast reconstruction (IBR). Conventional wisdom suggests that muscle coverage is somewhat protective against PMRT-related complications. In this study, the authors compared surgical outcomes in patients who underwent two-stage prepectoral versus subpectoral IBR in the setting of PMRT.
The authors performed a retrospective cohort study of patients who underwent mastectomy and PMRT with two-stage IBR from 2016 to 2019. The primary outcome was breast-related complications, including device infection; the secondary outcome was device explantation.
The authors identified 179 reconstructions (101 prepectoral and 78 subpectoral) in 172 patients with a mean follow-up time of 39.7 ± 14.4 months. There were no differences between the prepectoral and subpectoral reconstructions in rates of breast-related complications (26.7% and 21.8%, respectively; P = 0.274), device infection (18.8% and 15.4%, respectively; P = 0.307), skin flap necrosis (5.0% and 1.3%, respectively; P = 0.232), or device explantation (20.8% and 14.1%, respectively; P = 0.117). In adjusted models, compared with prepectoral device placement, subpectoral device placement was not associated with a lower risk of breast-related complications [hazard ratio (HR), 0.75; 95% confidence interval (CI), 0.41 to 1.36], device infection (HR, 0.73; 95% CI, 0.35 to 1.49), or device explantation (HR, 0.58; 95% CI, 0.28 to 1.19).
Device placement plane was not predictive of complication rates in IBR in the setting of PMRT. Two-stage prepectoral IBR provides safe long-term outcomes with acceptable postoperative complication rates comparable to those with subpectoral IBR, even in the setting of PMRT.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
在乳房重建（IBR）中，乳腺癌根治术后放疗（PMRT）会导致美容效果改变和更高的并发症发生率。传统观点认为肌肉覆盖在某种程度上可以预防 PMRT 相关并发症。在这项研究中，作者比较了 PMRT 背景下接受二期胸肌前置与胸肌后置 IBR 的患者的手术结果。
作者对 2016 年至 2019 年间接受乳房切除术和 PMRT 联合二期 IBR 的患者进行了回顾性队列研究。主要结局是乳房相关并发症，包括器械感染；次要结局是器械取出。
作者确定了 172 例患者的 179 例重建（101 例胸肌前置和 78 例胸肌后置），平均随访时间为 39.7 ± 14.4 个月。胸肌前置和胸肌后置重建的乳房相关并发症发生率无差异（分别为 26.7%和 21.8%；P = 0.274）、器械感染（分别为 18.8%和 15.4%；P = 0.307）、皮瓣坏死（分别为 5.0%和 1.3%；P = 0.232）或器械取出（分别为 20.8%和 14.1%；P = 0.117）。在调整后的模型中，与胸肌前置的器械放置相比，胸肌后置的器械放置与较低的乳房相关并发症风险无关[风险比（HR），0.75；95%置信区间（CI），0.41 至 1.36]、器械感染（HR，0.73；95% CI，0.35 至 1.49）或器械取出（HR，0.58；95% CI，0.28 至 1.19）。
在 PMRT 背景下，器械放置平面不能预测 IBR 的并发症发生率。二期胸肌前置 IBR 提供了安全的长期结果，其术后并发症发生率可接受，与胸肌后置 IBR 相当，即使在 PMRT 背景下也是如此。
临床问题/证据水平：治疗性，III 级。
