Couto-González Ivan, Fernández-Marcos Adrián Ángel, Brea-García Beatriz, González-Giménez Nerea, Canseco-Díaz Francisco, García-Arjona Belén, Mato-Codesido Cristina, Taboada-Suárez Antonio
Aesthet Surg J. 2023 Dec 14;44(1):NP60-NP68. doi: 10.1093/asj/sjad300.
Indications for breast-conserving surgery and adjuvant radiotherapy (BCSAR) in patients with breast carcinoma are increasing, as are indications for risk-reducing mastectomy (RRM) in healthy subjects. Most of these cases are reconstructed with silicone shell breast implants (SSBIs).
The aim of this work was to study complications of SSBIs in breast reconstruction in patients undergoing RRM with previous BCSAR.
A prospective cohort study was designed. The study group included cases of RRM reconstructed with SSBI in patients who had previously undergone BCSAR in the same breast. The control group consisted of patients with high-risk breast cancer who had undergone RRM and immediate SSBI reconstruction without previous BCSAR.
There was a history of BCSAR in 15.8% of cases. The first SSBI used in immediate reconstruction after RRM was replaced in 51.5% of cases with a mean [standard deviation] survival of 24.04 [28.48] months. BCSAR was significantly associated with pathological capsular contracture (P = .00) with this first SSBI (37.5% vs 5.9%). Of the cases requiring the replacement of the first SSBI, 44.23% suffered failure of the second SSBI, with a mean survival of 27.95 [26.53] months. No significant association was found between the consecutive development of capsular contracture in the second SSBI and a previous history of BCSAR (P = .10).
BCSAR prior to RRM reconstructed with an SSBI is associated with a significant increase in pathological capsular contracture. Patients should be warned of the high rate of SSBI complications and reconstruction failure. Polyurethane-coated implants may provide an alternative in cases in which alloplastic reconstruction is considered in patients with previous BCSAR.
乳腺癌患者保乳手术及辅助放疗（BCSAR）的适应证在增加，健康受试者预防性乳房切除术（RRM）的适应证也在增加。这些病例大多采用硅胶外壳乳房植入物（SSBI）进行重建。
本研究旨在探讨既往接受过BCSAR的患者在RRM乳房重建中使用SSBI的并发症。
设计了一项前瞻性队列研究。研究组包括在同一乳房先前接受过BCSAR的患者中用SSBI进行RRM重建的病例。对照组由患有高危乳腺癌且接受了RRM及即刻SSBI重建但既往未接受过BCSAR的患者组成。
15.8%的病例有BCSAR病史。RRM后即刻重建中首次使用的SSBI在51.5%的病例中被更换，平均[标准差]存活时间为24.04[28.48]个月。首次使用该SSBI时，BCSAR与病理性包膜挛缩显著相关（P = 0.00）（37.5%对5.9%）。在需要更换首次使用的SSBI的病例中，44.23%的第二次SSBI出现失败，平均存活时间为27.95[26.53]个月。第二次SSBI中包膜挛缩的连续发生与既往BCSAR病史之间未发现显著关联（P = 0.10）。
RRM前采用SSBI重建的BCSAR与病理性包膜挛缩的显著增加相关。应告知患者SSBI并发症和重建失败的高发生率。对于既往接受过BCSAR且考虑进行假体植入重建的患者，聚氨酯涂层植入物可能是一种替代选择。
