The Breast Unit at the Leeds Cancer Centre, St. James's University Hospital, Leeds, LS9 7TF, UK.
Department of Breast Surgery, Huddersfield Royal Infirmary, Huddersfield, HD3 3EA, UK.
Breast Cancer Res Treat. 2024 Nov;208(2):275-282. doi: 10.1007/s10549-024-07416-5. Epub 2024 Jul 10.
Implant-based breast reconstruction (IBR) is being increasingly performed with implant placed above the pectoral muscle (pre-pectoral), instead of below the pectoral muscle (sub-pectoral). Currently, there is a lack of comparative data on clinical and patient-perceived outcomes between pre- vs. sub-pectoral IBR. We investigated whether this difference in surgical approach influenced clinical or patient-perceived outcomes.
This prospective non-randomised longitudinal cohort study (ClinicalTrials.gov identifier: NCT04842240) recruited patients undergoing immediate IBR at the Leeds Breast Unit (Sep 2019-Sep 2021). Data collection included patient characteristics and post-operative complications. Patient-Reported Outcome Measures were collected using the BREAST-Q questionnaire at baseline, 2 weeks, 3- and 12-months post-surgery.
Seventy-eight patients underwent IBR (46 patients pre-pectoral; 59% vs. 32 patients sub-pectoral; 41%). Similar complication rates were observed (15.2% pre-pectoral vs. 9.4% sub-pectoral; p = 0.44). Overall implant loss rate was 3.8% (6.5% pre-pectoral vs. 0% sub-pectoral; p = 0.13). Respective median Breast-Q scores for pre- and sub-pectoral IBR at 3 months were: breast satisfaction (58 vs. 48; p = 0.01), psychosocial well-being (60 vs. 57; p = 0.9), physical well-being (68 vs. 76; p = 0.53), and Animation Q scores (73 vs. 76; p = 0.45). Respective Breast-Q scores at 12 months were: breast satisfaction (58 vs. 53; p = 0.3), psychosocial well-being (59 vs. 60; p = 0.9), physical well-being (68 vs. 78; p = 0.18), and Animation Q scores (69 vs. 73; p = 0.4).
This study demonstrates equivalent clinical and patient-perceived outcomes between pre- and sub-pectoral IBR. The study findings can be utilised to aid informed decision making regarding either surgical option.
与放置在胸肌下方（胸肌下）的植入物相比，越来越多的人采用植入物置于胸肌上方（胸肌前）的方法进行乳房重建（IBR）。目前，关于胸肌前与胸肌下 IBR 之间的临床和患者感知结果的比较数据尚缺乏。我们研究了这种手术方法的差异是否会影响临床或患者感知的结果。
这是一项前瞻性非随机纵向队列研究（ClinicalTrials.gov 标识符：NCT04842240），在利兹乳房科（Leeds Breast Unit）招募了 2019 年 9 月至 2021 年 9 月期间接受即刻 IBR 的患者。数据收集包括患者特征和术后并发症。使用 BREAST-Q 问卷在基线、2 周、3-12 个月时收集患者报告的结果。
78 例患者接受了 IBR（46 例胸肌前；59%与 32 例胸肌下；41%）。观察到相似的并发症发生率（胸肌前 15.2%与胸肌下 9.4%；p=0.44）。总体植入物丢失率为 3.8%（胸肌前 6.5%与胸肌下 0%；p=0.13）。3 个月时胸肌前和胸肌下 IBR 的分别的 Breast-Q 评分中位数为：乳房满意度（58 分与 48 分；p=0.01），社会心理幸福感（60 分与 57 分；p=0.9），生理健康（68 分与 76 分；p=0.53）和动画 Q 评分（73 分与 76 分；p=0.45）。12 个月时的 Breast-Q 评分分别为：乳房满意度（58 分与 53 分；p=0.3），社会心理幸福感（59 分与 60 分；p=0.9），生理健康（68 分与 78 分；p=0.18）和动画 Q 评分（69 分与 73 分；p=0.4）。
本研究表明胸肌前和胸肌下 IBR 具有等效的临床和患者感知结果。研究结果可用于辅助有关两种手术方案的知情决策。
