Ma Tianyi, Ma Teng, Li Xiangjun, Sun Xinyi, Cao Weihong, Niu Zhaohe, Wang Haibo
Department of Breast Center, the Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, Shandong, 266000, China.
Medical Department, Qingdao University, Qingdao, Shandong, 266000, China.
World J Surg Oncol. 2024 Dec 21;22(1):347. doi: 10.1186/s12957-024-03618-9.
Postmastectomy radiation therapy (PMRT) can influence the outcome of implant-based breast reconstruction (IBBR). This study aims to investigate the complications and patient-reported outcomes (PROs) following PMRT between direct-to-implant (DTI) and tissue expander-to-implant (TEI) reconstruction.
The retrospective study included breast cancer patients undergoing IBBR and PMRT. Patients were divided into a permanent implant group (PI-PMRT) and a tissue expander group (TE-PMRT). Complications, reconstruction failure, and reoperation were compared between the two groups. PROs were assessed using the BREAST-Q scale.
A total of 203 patients were included: 99 in the PI-PMRT group and 104 in the TE-PMRT group. The incidence of severe capsular contracture was significantly higher in the PI-PMRT group compared to the TE-PMRT group (37.4% vs. 24.0%, p = 0.039). The PI-PMRT group had a significantly lower rate of reconstruction failure (9.1% vs. 19.2%, p = 0.039) and reoperation (13.1% vs. 24.0%, p = 0.046). Multivariate analysis revealed that the absence of mesh (OR = 2.177, p = 0.040) and DTI reconstruction (OR = 1.922, p = 0.046) were independent predictors of severe capsular contracture; the absence of mesh (OR = 4.699, p = 0.015) and TEI reconstruction (OR = 2.429, p = 0.043) were independent predictors of reconstruction failure. BREAST-Q scores indicated greater breast satisfaction in the PI-PMRT group (p = 0.031).
Although DTI reconstruction resulted in a higher risk of severe capsular contracture, the higher risk of reconstruction failure and reoperation in patients undergoing TEI reconstruction was even more concerning. Furthermore, patients were more likely to report greater breast satisfaction with DTI reconstruction. Therefore, DTI reconstruction may be a more appropriate option for patients anticipating PMRT.
乳房切除术后放疗（PMRT）会影响基于植入物的乳房重建（IBBR）的效果。本研究旨在调查直接植入式（DTI）和组织扩张器-植入式（TEI）重建术后PMRT的并发症及患者报告结局（PROs）。
这项回顾性研究纳入了接受IBBR和PMRT的乳腺癌患者。患者被分为永久植入物组（PI-PMRT）和组织扩张器组（TE-PMRT）。比较两组之间的并发症、重建失败和再次手术情况。使用BREAST-Q量表评估PROs。
共纳入203例患者：PI-PMRT组99例，TE-PMRT组104例。PI-PMRT组严重包膜挛缩的发生率显著高于TE-PMRT组（37.4%对24.0%，p = 0.039）。PI-PMRT组的重建失败率（9.1%对19.2%，p = 0.039）和再次手术率（13.1%对24.0%，p = 0.046）显著更低。多因素分析显示，无网片（OR = 2.177，p = 0.040）和DTI重建（OR = 1.922，p = 0.046）是严重包膜挛缩的独立预测因素；无网片（OR = 4.699，p = 0.015）和TEI重建（OR = 2.429，p = 0.043）是重建失败的独立预测因素。BREAST-Q评分表明PI-PMRT组患者对乳房的满意度更高（p = 可编辑文档，以下是为您添加的注释，方便您理解：
