From the Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine.
Department of Convergence Science, College of Medicine, Catholic Kwandong University International St. Mary's Hospital.
Plast Reconstr Surg. 2024 Jan 1;153(1):10e-24e. doi: 10.1097/PRS.0000000000010493. Epub 2023 Apr 4.
Implant-based breast reconstruction has evolved over time. However, the effects of prepectoral breast reconstruction (PBR) compared with those of subpectoral breast reconstruction (SBR) have not been clearly defined. Therefore, this study aimed to compare the occurrence of surgical complications between PBR and SBR to determine the procedure that is effective and relatively safe.
The PubMed, Cochrane Library, and EMBASE databases were searched for studies published until April of 2021 comparing PBR and SBR following mastectomy. Two authors independently assessed the risk of bias. General information on the studies and surgical outcomes were extracted. Among 857 studies, 34 and 29 were included in the systematic review and meta-analysis, respectively. Subgroup analysis was performed to clearly compare the results of patients who underwent postmastectomy radiation therapy.
Pooled results showed that prevention of capsular contracture (OR, 0.57; 95% CI, 0.41 to 0.79) and infection control (OR, 0.73; 95% CI, 0.58 to 0.92) were better with PBR than with SBR. Rates of hematoma, implant loss, seroma, skin-flap necrosis, and wound dehiscence were not significantly different between PBR and SBR. PBR considerably improved postoperative pain, BREAST-Q score, and upper arm function compared with SBR. Among postmastectomy radiation therapy patients, the incidence rates of capsular contracture were significantly lower in the PBR group than in the SBR group (OR, 0.14; 95% CI, 0.05 to 0.35).
The results showed that PBR had fewer postoperative complications than SBR. The authors' meta-analysis suggests that PBR could be used as an alternative technique for breast reconstruction in appropriate patients.
随着时间的推移，基于植入物的乳房重建已经发展。然而，与胸肌下乳房重建（SBR）相比，胸肌前乳房重建（PBR）的效果尚未明确界定。因此，本研究旨在比较 PBR 和 SBR 后乳房重建手术并发症的发生率，以确定有效且相对安全的手术方法。
检索了截至 2021 年 4 月发表的比较乳房切除术后 PBR 和 SBR 的 PubMed、Cochrane 图书馆和 EMBASE 数据库。两位作者独立评估了偏倚风险。提取了关于研究和手术结果的一般信息。在 857 项研究中，有 34 项和 29 项分别纳入了系统评价和荟萃分析。进行了亚组分析，以清楚地比较接受乳房切除术后放疗的患者的结果。
汇总结果表明，与 SBR 相比，PBR 更能预防包膜挛缩（OR，0.57；95%CI，0.41 至 0.79）和感染控制（OR，0.73；95%CI，0.58 至 0.92）。PBR 和 SBR 之间的血肿、植入物丢失、血清肿、皮瓣坏死和伤口裂开发生率无显著差异。与 SBR 相比，PBR 显著改善了术后疼痛、BREAST-Q 评分和上臂功能。在接受乳房切除术后放疗的患者中，PBR 组的包膜挛缩发生率明显低于 SBR 组（OR，0.14；95%CI，0.05 至 0.35）。
结果表明，PBR 的术后并发症少于 SBR。作者的荟萃分析表明，在适当的患者中，PBR 可以作为乳房重建的替代技术。
