Lisa Andrea, Riccardi Francesca, Alessandri-Bonetti Mario, Mazzocconi Luca, Bottoni Manuela, Barbieri Benedetta, Gottardi Alessandra, Palmesano Marco, Cervelli Valerio, Bagnardi Vincenzo, Pagan Eleonora, Veronesi Paolo, De Lorenzi Francesca, Rietjens Mario
Department of Plastic Surgery, IRCCS European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy; Applied Medical Surgical Sciences, Department of Surgical Sciences, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy.
Department of Plastic Surgery, IRCCS European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.
Breast. 2025 Jun 26;83:104520. doi: 10.1016/j.breast.2025.104520.
Implant-based reconstruction (IBR) is the most common reconstructive strategy following mastectomy. Advancements in surgical techniques and materials have led to improvement in perfusion and thickness of mastectomy skin flaps and they have renewed interest in prepectoral breast reconstruction (PBR). The aim of this study was to analyze the surgical outcomes of skin or nipple-sparing mastectomies with direct-to-implant (DTI) reconstructions with prepectoral polyurethane foam-coated implants.
A retrospective study was conducted on consecutive patients undergoing postmastectomy IBR-DTI with prepectoral polyurethane foam-coated implants between 2020 and 2022. Inclusion criteria were a preoperative pinch test >0.8 cm and well-perfused mastectomy flaps. Preoperative radiation therapy was not an exclusion criterium. Complications were classified as "major" if they required urgent re-intervention, and as "minor" if they required only outpatient management.
A total of 250 patients and 317 breast reconstructions were included. The mean (±SD) age was 50.5 ± 10.9 years with a mean BMI of 23.8 ± 4.0. The mean follow-up was 12.2 ± 1.2 months. The overall rate of major complications was 6.3 %, being infection the most common major complication (2.5 %), followed by mastectomy flap necrosis (1.6 %), bleeding (1.6 %), and wound dehiscence (0.6 %). The overall minor complications rate was 27.8 %. Across minor complications, rippling was recorded as the most common (14.5 %), followed by capsular contracture (7.6 %), seroma formation (2.5 %), skin necrosis (2.2 %), hematoma (0.6 %) and wound dehiscence (0.3 %).
In our cohort, DTI-PBR with PU implants had a 6.3 % risk of major complications requiring urgent re-intervention. Hypothyroidism, diabetes, and overweight have been identified as risk factors associated with higher risk of complications.
基于植入物的重建（IBR）是乳房切除术后最常见的重建策略。手术技术和材料的进步使乳房切除皮瓣的灌注和厚度得到改善，并重新引发了对胸肌前乳房重建（PBR）的兴趣。本研究的目的是分析采用胸肌前聚氨酯泡沫涂层植入物进行直接植入（DTI）重建的保皮肤或保乳头乳房切除术的手术效果。
对2020年至2022年间连续接受乳房切除术后IBR-DTI并使用胸肌前聚氨酯泡沫涂层植入物的患者进行回顾性研究。纳入标准为术前捏皮试验>0.8 cm且乳房切除皮瓣血运良好。术前放疗不是排除标准。如果并发症需要紧急再次干预则分类为“严重”，如果仅需要门诊处理则分类为“轻微”。
共纳入250例患者和317例乳房重建。平均（±标准差）年龄为50.5±10.9岁，平均BMI为23.8±4.0。平均随访时间为12.2±1.2个月。严重并发症的总体发生率为6.3%，其中感染是最常见的严重并发症（2.5%），其次是乳房切除皮瓣坏死（1.6%）、出血（1.6%）和伤口裂开（0.6%）。轻微并发症的总体发生率为27.8%。在轻微并发症中，波纹最常见（14.5%），其次是包膜挛缩（7.6%）、血清肿形成（2.5%）、皮肤坏死（2.2%）、血肿（0.6%）和伤口裂开（0.3%）。
在我们的队列中，采用聚氨酯植入物的DTI-PBR有6.3%的风险发生需要紧急再次干预的严重并发症。甲状腺功能减退、糖尿病和超重已被确定为与较高并发症风险相关的危险因素。
