Moon Sohyun, Min Kyunghyun, Kim Tae Ho, Um Jung Hwan, Kook Yoonwon, Baek Seung Ho, Yun In Sik, Roh Tai Suk, Bae Soong June, Jeong Joon, Ahn Sung Gwe, Kim Young Seok
Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Institute for Breast Cancer Precision Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
J Breast Cancer. 2024 Dec;27(6):395-406. doi: 10.4048/jbc.2024.0141.
Capsular contracture (CC) is a concerning issue for individuals undergoing postmastectomy radiation therapy (PMRT) with implant-based breast reconstruction. This study investigated whether the extent of CC and implant migration differs based on implant placement and the reconstruction stage. Insertion plane and stage of breast implants were investigated, and the presence and severe cases of CC and implant migration were analyzed. Among 195 participants, 83 were in the pre-pectoral group, and 112 were in the sub-pectoral group. Two-staged surgery was performed on 116 patients, while 79 underwent direct-to-implant (DTI). Notably, The occurrence of CC (prepectoral, 17 [20.48%] and subpectoral, 42 [37.50%]; = 0.011), CC severity (prepectoral, 4 [4.82%] and subpectoral, 17 [15.17%]; = 0.021), and implant upward migration (prepectoral, 15 [18.07%] and subpectoral, 38 [33.92%]; = 0.014) significantly varied between the two groups. The incidence of CC was more common in the DTI group (odds ratio [OR], 2.283; 95% confidence interval [CI], 1.164-4.478). Furthermore, subpectoral placement was an independent risk factor for occurrence (OR, 2.989; 95% CI, 1.476-6.054) and severity of CC (OR, 38.552; 95% CI, 1.855-801.186) and upward implant migration (OR, 2.531; 95% CI, 1.263-5.071). Our findings suggest that pre-pectoral reconstruction and the two-stage operation benefit patients who may undergo PMRT. These approaches can help reduce the incidence of CC and abnormal implant migration following radiation, leading to improved aesthetic outcomes and greater patient satisfaction.
对于接受基于植入物的乳房重建的乳房切除术后放疗（PMRT）患者而言，包膜挛缩（CC）是一个令人担忧的问题。本研究调查了CC的程度和植入物移位是否因植入物放置位置和重建阶段而异。研究了乳房植入物的植入平面和阶段，并分析了CC和植入物移位的存在情况及严重病例。在195名参与者中，83名属于胸肌前组，112名属于胸肌后组。116名患者接受了两阶段手术，79名患者接受了直接植入（DTI）。值得注意的是，两组之间CC的发生率（胸肌前组为17例[20.48%]，胸肌后组为42例[37.50%]；P = 0.011）、CC严重程度（胸肌前组为4例[4.82%]，胸肌后组为17例[15.17%]；P = 0.021）以及植入物向上移位（胸肌前组为15例[18.07%]，胸肌后组为38例[33.92%]；P = 0.014）存在显著差异。CC的发生率在DTI组中更为常见（优势比[OR]为2.283；95%置信区间[CI]为1.164 - 4.478）。此外，胸肌后放置是CC发生（OR为2.989；95%CI为1.476 - 6.054）、严重程度（OR为38.552；95%CI为1.855 - 801.186）以及植入物向上移位（OR为2.531；95%CI为1.263 - 5.071）的独立危险因素。我们的研究结果表明，胸肌前重建和两阶段手术对可能接受PMRT的患者有益。这些方法有助于降低放疗后CC的发生率和植入物异常移位，从而改善美学效果并提高患者满意度。
