Escandón Joseph M, Langstein Howard N, Christiano Jose G, Gooch Jessica C, Prieto Peter A, Aristizábal Alejandra, Weiss Anna, Manrique Oscar J
Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA.
Division of Surgical Oncology, Department of Surgery, Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA.
Aesthetic Plast Surg. 2024 Jun;48(11):2088-2097. doi: 10.1007/s00266-023-03536-3. Epub 2023 Aug 10.
There is limited evidence regarding the factors causing a prolonged time for tissue expander (TE) exchange into a definitive implant using two-stage implant-based breast reconstruction (IBBR). This study aimed to review our experience with IBBR, focusing on the time for TE-to-implant exchange and determining which factors cause a prolonged time for exchange.
A retrospective review was performed to include women undergoing immediate two-stage IBBR with TEs after total mastectomy between January 2011 and May 2021. Reconstructions with irradiated TEs were excluded. Cases that had a prolonged time for TE-to-implant exchange were defined as those undergoing exchange longer than 232 days, which corresponds to the 75th percentile of the overall study group.
We included 442 reconstructions in our analysis. The median age for our series was 51 years and the median body mass index was 26.43-kg/m. The median time for TE-to-implant exchange was 155 days [IQR, 107-232]. Cases that had a prolonged time for TE-to-implant exchange were defined as those undergoing exchange on postoperative day 232 or afterward. Diabetes (OR 4.05, p = 0.006), neoadjuvant chemotherapy (OR 2.76, p = 0.006), an increased length of stay (OR 1.54, p = 0.013), and a lengthier time to complete outpatient expansions (OR 1.018, p < 0.001) were independently associated with a prolonged time for exchange.
As evident from our analysis, the time for exchange is highly heterogeneous among patients. Although several factors affect the timing for TE-to-implant exchange, efforts must be directed to finalize outpatient expansions as soon as possible to expedite the transition into a definitive implant.
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关于在基于植入物的两阶段乳房重建（IBBR）中，导致组织扩张器（TE）更换为最终植入物的时间延长的因素，证据有限。本研究旨在回顾我们在IBBR方面的经验，重点关注TE更换为植入物的时间，并确定哪些因素会导致更换时间延长。
进行了一项回顾性研究，纳入2011年1月至2021年5月期间在全乳切除术后接受即刻两阶段IBBR并使用TE的女性。排除使用过放射治疗的TE的重建病例。TE更换为植入物的时间延长的病例定义为更换时间超过232天的病例，这对应于整个研究组的第75百分位数。
我们的分析纳入了442例重建病例。我们系列的中位年龄为51岁，中位体重指数为26.43kg/m²。TE更换为植入物的中位时间为155天[四分位间距，107 - 232天]。TE更换为植入物的时间延长的病例定义为在术后第232天或之后进行更换的病例。糖尿病（比值比4.05，p = 0.006）、新辅助化疗（比值比2.76，p = 0.006）、住院时间延长（比值比1.54，p = 0.013）以及完成门诊扩张的时间更长（比值比1.018，p < 0.001）与更换时间延长独立相关。
从我们的分析中可以明显看出，患者之间的更换时间差异很大。尽管有几个因素会影响TE更换为植入物的时间，但必须努力尽快完成门诊扩张，以加快过渡到最终植入物。
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