Bryan Jaimie L, Ockerman Kyle M, Spiguel Lisa R, Cox Elizabeth A, Han Sabrina H, Trieu Nhan, Blondin Fernandez Mario, Heath Frederick, Sorice-Virk Sarah
Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Palo Alto, CA, USA.
College of Medicine, University of Florida, Gainesville, FL, USA.
Plast Surg (Oakv). 2024 Aug 30:22925503241276541. doi: 10.1177/22925503241276541.
Post-mastectomy implant-based reconstruction can be performed as direct-to-implant (DTI) or two-staged reconstruction (TSR). Rigorous studies have explored postoperative complications between TSR or DTI, yet few have stratified outcomes by relevant populations, pre-operative findings, mastectomy characteristics, or plane of implant placement. We sought to compare the outcomes between these cohorts at our institution. All patients who underwent skin- or nipple-sparing mastectomy followed by DTI or TSR from 2011 to 2021 at a large academic medical center were included. Data included demographics, ADM use, mastectomy weight, plane of implant placement, and postoperative complications. 295 patients were included. 271 (91.9%) received TSR, and 24 (8.1%) underwent DTI. Compared to TSR, DTI had a higher rate of NAC necrosis ( = .007) and dehiscence ( = .016). There was no difference in rate of other complications. Regardless of procedure, higher BMI ( = .002), higher grade ptosis ( = .01), and larger mastectomy weights ( = .022) were associated with increased risk of complication. Pre-pectoral placement was not associated with risk of NAC or mastectomy skin necrosis. Prior tobacco use was associated with higher risk of infection ( = .036) and dehiscence ( = .025). Neoadjuvant and adjuvant chemotherapy was associated with increased risk of capsular contracture( = .009). Our study suggests that TSR may be preferred to minimize risk of NAC necrosis and wound dehiscence, especially in high-risk patients. Pre-pectoral placement did not significantly affect risk of mastectomy or NAC necrosis and should be considered in all cases to minimize morbidity. Higher risk conditions for alloplastic reconstruction include higher degrees of ptosis, history of tobacco use, and higher BMIs.
乳房切除术后植入物重建可采用直接植入（DTI）或两阶段重建（TSR）。已有严谨的研究探讨了TSR和DTI术后并发症情况，但很少有研究按相关人群、术前检查结果、乳房切除术特征或植入物放置平面进行分层分析。我们试图比较本院这两组患者的治疗结果。纳入了2011年至2021年期间在一家大型学术医疗中心接受保乳或保留乳头乳房切除术后行DTI或TSR的所有患者。数据包括人口统计学资料、ADM使用情况、乳房切除重量、植入物放置平面及术后并发症。共纳入295例患者。271例（91.9%）接受TSR，24例（8.1%）接受DTI。与TSR相比，DTI的乳头乳晕复合体（NAC）坏死率更高（P = 0.007），裂开率更高（P = 0.016）。其他并发症发生率无差异。无论采用何种手术方式，较高的体重指数（P = 0.002）、更严重的乳房下垂（P = 0.01）和更大的乳房切除重量（P = 0.022）与并发症风险增加相关。胸肌前放置与NAC或乳房切除皮肤坏死风险无关。既往吸烟与感染风险更高（P = 0.036）和裂开风险更高（P = 0.025）相关。新辅助和辅助化疗与包膜挛缩风险增加相关（P = 0.009）。我们的研究表明，TSR可能更可取，以尽量降低NAC坏死和伤口裂开的风险，尤其是在高危患者中。胸肌前放置对乳房切除或NAC坏死风险无显著影响，在所有病例中均应考虑采用，以尽量降低发病率。假体重建的高风险情况包括更严重的乳房下垂、吸烟史和更高的体重指数。
