Department of Breast Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China.
Department of Radiation Therapy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China.
Medicine (Baltimore). 2024 Mar 8;103(10):e37365. doi: 10.1097/MD.0000000000037365.
Controversies regarding the risk factors affecting direct-to-implant (DTI) immediate breast reconstruction still exist. This study aimed to evaluate the risk factors for severe complications in DTI breast reconstruction and explore potential salvage management strategies. We conducted a retrospective review of 238 patients (240 breasts) who underwent DTI immediate breast reconstruction between 2011 and 2020. Multivariate logistic regression analyses were used to identify the risk factors predicting severe complications. Seventeen (7.08%) reconstructed breasts experienced severe complications, of which only 5 were successfully salvaged through surgical revision, while the others failed and resulted in implant removal. Multivariate analyses demonstrated that mesh use [odds ratio (OR) = 4.054, 95% confidence interval: 1.376-11.945, P = .011] and post-mastectomy radiotherapy (odds ratio = 4.383, 95% confidence interval 1.142-16.819, P = .031) were independent predictors of severe complications. Mesh use and post-mastectomy radiotherapy for breast reconstruction increase the risk of severe complications. Despite positive surgical treatment, the successful salvage rate was poor.
关于影响直接植入（DTI）即刻乳房重建的风险因素仍存在争议。本研究旨在评估 DTI 即刻乳房重建严重并发症的风险因素，并探讨潜在的挽救管理策略。我们回顾性分析了 2011 年至 2020 年间接受 DTI 即刻乳房重建的 238 例（240 侧）患者。采用多变量逻辑回归分析来确定预测严重并发症的风险因素。17 例（7.08%）重建乳房发生严重并发症，其中仅 5 例通过手术修正成功挽救，而其他病例则失败并导致植入物移除。多变量分析表明，使用网片[比值比（OR）=4.054，95%置信区间：1.376-11.945，P=.011]和乳房切除术后放疗（OR=4.383，95%置信区间 1.142-16.819，P=.031）是严重并发症的独立预测因素。乳房重建中使用网片和乳房切除术后放疗会增加严重并发症的风险。尽管进行了积极的手术治疗，但挽救的成功率仍然很差。
