Elmorsi Rami, Barrera Jose E, Mericli Alexander F, Schaverien Mark V, Baumann Donald P, Olenczak J Bryce
From the Department of Plastic Surgery, University of Texas MD Anderson Cancer Center.
Plast Reconstr Surg. 2025 Jul 1;156(1):9-15. doi: 10.1097/PRS.0000000000011909. Epub 2024 Dec 3.
Two-stage prosthetic breast reconstruction involves the exchange of tissue expanders for implants, but complications of this procedure can necessitate revision operations and implant removal. The choice between remote incision (RI) and traditional access through the existing mastectomy scar (MS) for this exchange remains underexplored. RIs offer potential benefits by placing the incision at a region of higher quality tissue, prompting our comparative analysis of complications between RIs and MS.
The authors retrospectively analyzed patients undergoing expander-to-implant exchange by means of RI or MS access from 2018 through 2023. Data on demographics, comorbidities, cancer characteristics, operations, therapies, and outcomes were collected from the electronic medical record, and complication rates were compared between RI and MS exchange procedures.
In propensity score-matched cohorts, overall complications (10% for MS and 7.5% for RI; P = 0.58), infection (5.0% for MS versus 2.5% for RI; P = 0.68), seroma (2.5% for both; P > 0.99), dehiscence (2.5% for both; P > 0.99), implant exposure (2.5% for MS versus 1.2% for RI; P > 0.99), and implant explantation (7.5% for MS versus 6.2% for RI; P = 0.75) were similar or lower in the RI group. Overall complications, infection, seroma, dehiscence, implant exposure, and explantation were also lower in irradiated patients receiving RI compared with MS exchanges, although the differences were statistically insignificant. Transaxillary and inframammary incisions showed comparable outcomes, with the latter having a higher incidence of infections.
RIs represent a safe alternative to MS exchanges in selected, high-risk patients undergoing postmastectomy implant-based breast reconstruction.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
两阶段假体乳房重建涉及将组织扩张器更换为植入物，但该手术的并发症可能需要进行修复手术并取出植入物。对于这种更换手术，在远离乳房切除术瘢痕（MS）的部位做切口（RI）与通过现有的乳房切除术瘢痕进行传统入路之间的选择仍未得到充分研究。RI通过将切口置于组织质量较高的区域而具有潜在优势，促使我们对RI和MS的并发症进行比较分析。
作者回顾性分析了2018年至2023年期间通过RI或MS入路进行扩张器至植入物更换的患者。从电子病历中收集了人口统计学、合并症、癌症特征、手术、治疗及结果等数据，并比较了RI和MS更换手术的并发症发生率。
在倾向评分匹配队列中，总体并发症（MS组为(10%)，RI组为(7.5%)；(P = 0.58)）、感染（MS组为(5.0%)，RI组为(2.5%)；(P = 0.68)）、血清肿（两组均为(2.5%)；(P > 0.99)）、裂开（两组均为(2.5%)；(P > 0.99)）、植入物外露（MS组为(2.5%)，RI组为(1.2%)；(P > 0.99)）和植入物取出（MS组为(7.5%)，RI组为(6.2%)；(P = 0.75)）在RI组中相似或更低。与接受MS更换的放疗患者相比，接受RI的放疗患者的总体并发症、感染、血清肿、裂开、植入物外露和取出也更低，尽管差异无统计学意义。经腋窝和乳房下皱襞切口的结果相当，后者感染发生率更高。
对于接受乳房切除术后基于植入物的乳房重建的特定高危患者，RI是MS更换的一种安全替代方法。
临床问题/证据水平：治疗性，III级
