Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, De Boelelaan 1117, Amsterdam, the Netherlands.
Amsterdam UMC location Vrije Universiteit Amsterdam, Medical Library, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.
J Plast Reconstr Aesthet Surg. 2023 Nov;86:109-127. doi: 10.1016/j.bjps.2023.08.021. Epub 2023 Aug 19.
Most breast reconstructions are implant-based and can be performed either in a one-stage, direct-to-implant or in a two-stage, expander-implant-based reconstruction. The objective of this systematic review is to compare the safety and patient satisfaction of the two reconstruction approaches.
A literature search was conducted on 27 September 2022 using various databases. Studies comparing one-stage and two-stage implant reconstructions and reporting the following outcomes were included: patient satisfaction, aesthetics, complications, and/or costs. Reviews, case reports, or series with less than 20 patients and letters or comments were excluded. Comparisons were made between the one-stage reconstruction with and without acellular dermal matrix (ADM) and two-stage implant-based breast reconstruction groups. The data extracted from all articles were analysed using random-effects meta-analyses.
Of the 1381 records identified, a total of 33 articles were included, representing 21529 patients. There were no significant differences between the one-stage and two-stage groups, except for the costs. The one-stage operation without ADM had lower costs than the two-stage operation without ADM, although the use of an ADM substantially increased the price of the operation to more than a two-stage reconstruction.
Equal patient satisfaction, aesthetic outcomes, and complication rates with lower costs justify one-stage breast reconstruction in carefully selected patients. This review shows that there is no evidence-based superior surgical approach. Future research should focus on the costs of the ADM versus an additional stage and patient-reported outcomes.
大多数乳房重建是基于植入物的，可以采用一期直接植入或二期扩张器-植入物重建的方法进行。本系统评价的目的是比较两种重建方法的安全性和患者满意度。
于 2022 年 9 月 27 日使用多个数据库进行文献检索。纳入比较一期和二期植入物重建并报告以下结局的研究：患者满意度、美观、并发症和/或成本。排除综述、病例报告或少于 20 例的病例系列以及信件或评论。比较了无脱细胞真皮基质（ADM）的一期重建和二期植入物乳房重建组之间的差异。使用随机效应荟萃分析对所有文章中提取的数据进行分析。
在确定的 1381 条记录中，共有 33 篇文章被纳入，代表了 21529 名患者。除了成本之外，一期和二期组之间没有显著差异。无 ADM 的一期手术成本低于无 ADM 的二期手术，尽管使用 ADM 会大大增加手术费用，使其超过二期重建。
在精心挑选的患者中，一期乳房重建具有同等的患者满意度、美观结局和并发症发生率，且成本更低，这是合理的。本综述表明，目前没有基于证据的更优手术方法。未来的研究应侧重于 ADM 与额外阶段的成本以及患者报告的结果。
