Spoer Daisy L, Berger Lauren E, Huffman Samuel S, Lava Christian X, Dekker Paige K, Ko JiMin A, Truong Brian N, Towfighi Parhom N, Ghyasi Niloofar, Fan Kenneth L, Song David H
From the Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital.
Georgetown University School of Medicine.
Plast Reconstr Surg. 2024 Oct 1;154(4S):27S-40S. doi: 10.1097/PRS.0000000000011400. Epub 2024 Sep 20.
Autologous breast reconstruction confers favorable patient reports of satisfaction and quality of life compared with implant-based reconstruction over a lifetime. The latissimus dorsi with immediate fat transfer (LIFT) is an alternative approach to abdominally based free flaps (Ab-FF), which expands fully autologous reconstruction to nonmicrosurgeons. This study compared the 2 procedures concerning their clinical and patient-reported outcomes 1 year postoperatively.
The authors conducted a retrospective review of LIFTs and Ab-FFs performed between March of 2017 and August of 2022. The primary outcomes were postoperative complications, reoperations, and longitudinal BREAST-Q scores. BREAST-Q modules included Satisfaction with Breasts, Satisfaction with Abdomen, Satisfaction with Back, Psychosocial Well-being, Physical Well-being: Chest, Physical Well-being: Abdomen, Physical Well-being: Back, and Sexual Well-being.
Of the 281 included patients (408 breasts), 211 received Ab-FF and 70 received LIFT. One-year follow-up (median [interquartile range], 12 [12] months) demonstrated that Ab-FF independently predicted dehiscence, reoperation procedures, and revisional surgery. LIFT independently increased the odds of seroma. Obesity predicted dehiscence, and bilateral reconstructions predicted revisional fat grafting. BREAST-Q scores fluctuated over time but were similar across all measured domains by 1 year postoperatively.
Although Ab-FF is the standard approach for fully autologous reconstruction, LIFT procedures may be associated with a less complicated postoperative course while eliciting similar patient-reported outcomes. LIFT may be preferred to limit postoperative complications, particularly in patients with obesity. LIFT can be used by plastic surgeons who are not trained in microsurgical procedures or do not have an environment that fosters Ab-FF.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
与基于植入物的乳房重建相比，自体乳房重建在患者的一生当中能带来更高的满意度和生活质量报告。背阔肌肌皮瓣即刻脂肪移植（LIFT）是一种替代腹部游离皮瓣（Ab-FF）的方法，它将完全自体乳房重建扩展到非显微外科医生。本研究比较了这两种手术在术后1年的临床和患者报告结局。
作者对2017年3月至2022年8月期间进行的LIFT和Ab-FF手术进行了回顾性研究。主要结局指标为术后并发症、再次手术以及纵向BREAST-Q评分。BREAST-Q模块包括对乳房的满意度、对腹部的满意度、对背部的满意度、心理社会幸福感、身体健康：胸部、身体健康：腹部、身体健康：背部以及性幸福感。
在纳入研究的281例患者（408侧乳房）中，211例接受了Ab-FF手术，70例接受了LIFT手术。1年随访（中位数[四分位间距]，12[12]个月）显示，Ab-FF独立预测了伤口裂开、再次手术和修复手术。LIFT独立增加了血清肿的发生率。肥胖预测伤口裂开，双侧重建预测修复性脂肪移植。BREAST-Q评分随时间波动，但术后1年时在所有测量领域中相似。
虽然Ab-FF是完全自体乳房重建的标准方法，但LIFT手术可能与较简单的术后过程相关，同时能获得相似的患者报告结局。LIFT可能更适合用于限制术后并发症，尤其是肥胖患者。未接受显微外科手术培训或没有开展Ab-FF手术条件的整形外科医生也可以使用LIFT手术。
临床问题/证据级别：治疗性，III级
