Hospital Geral de Fortaleza FortalezaCE Brazil Hospital Geral de Fortaleza, Fortaleza, CE, Brazil.
Instituto Oncoclínicas São PauloSP Brazil Instituto Oncoclínicas, São Paulo, SP, Brazil.
Rev Bras Ginecol Obstet. 2024 Sep 6;46. doi: 10.61622/rbgo/2024rbgo76. eCollection 2024.
To evaluate early complications in prepectoral breast reconstruction.
A retrospective cohort study including 180 consecutive cases of nipple-sparing mastectomy, comparing immediate breast reconstruction with subpectoral to prepectoral mammary implants in 2012-2022. Clinical and demographic characteristics and complications in the first three months following surgery were compared between the two techniques.
The prepectoral technique was used in 22 cases (12.2%) and the subpectoral in 158 (87.8%). Median age was higher in the prepectoral group (47 versus 43.8 years; p=0.038), as was body mass index (25.1 versus 23.8; p=0.002) and implant volume (447.5 versus 409 cc; p=0.001). The prepectoral technique was more associated with an inframammary fold (IMF) incision (19 cases, 86.4% versus 85, 53.8%) than with periareolar incisions (3 cases, 13.6% versus 73, 46.2%); (p=0.004). All cases in the prepectoral group underwent direct-to-implant reconstruction compared to 54 cases (34.2%) in the subpectoral group. Thirty-eight complications were recorded: 36 (22.8%) in the subpectoral group and 2 (9.1%) in the prepectoral group (p=0.24). Necrosis of the nipple-areola complex/skin flap occurred in 27 patients (17.1%) in the subpectoral group (prepectoral group: no cases; p=0.04). The groups were comparable regarding dehiscence, seroma, infection, and hematoma. Reconstruction failed in one case per group (p=0.230). In the multivariate analysis, IMF incision was associated with the prepectoral group (aOR: 34.72; 95%CI: 2.84-424.63).
The incidence of early complications was comparable between the two techniques and compatible with previous reports. The clinical and demographic characteristics differed between the techniques. Randomized clinical trials are required.
评估胸肌前乳房重建的早期并发症。
回顾性队列研究纳入了 180 例连续接受保留乳头的乳房切除术患者，比较了 2012 年至 2022 年期间即刻乳房重建与胸肌下和胸肌前乳房植入物的情况。比较了两种技术术后前三个月的临床和人口统计学特征及并发症。
胸肌前技术用于 22 例（12.2%），胸肌下技术用于 158 例（87.8%）。胸肌前组的中位年龄较高（47 岁比 43.8 岁；p=0.038），体重指数（25.1 比 23.8；p=0.002）和植入物体积（447.5 比 409 cc；p=0.001）也较高。与乳晕切口（19 例，86.4%比 85 例，53.8%）相比，胸肌前技术更常采用下皱襞（IMF）切口（3 例，13.6%比 73 例，46.2%）；（p=0.004）。与胸肌下组 54 例（34.2%）相比，胸肌前组所有病例均行直接植入物重建。记录了 38 例并发症：胸肌下组 36 例（22.8%），胸肌前组 2 例（9.1%）（p=0.24）。胸肌下组有 27 例（17.1%）发生乳头乳晕复合体/皮瓣坏死（胸肌前组无病例；p=0.04）。两组在切口裂开、血清肿、感染和血肿方面相似。每组均有 1 例重建失败（p=0.230）。多因素分析显示，IMF 切口与胸肌前组相关（aOR：34.72；95%CI：2.84-424.63）。
两种技术的早期并发症发生率相似，与以往报道一致。两种技术的临床和人口统计学特征不同。需要进行随机临床试验。
