Evans G R, Schusterman M A, Kroll S S, Miller M J, Reece G P, Robb G L, Ainslie N
Department of Plastic Surgery, University of Texas, M.D. Anderson Cancer Center, Houston, USA.
Plast Reconstr Surg. 1995 Oct;96(5):1111-5; discussion, 1116-8.
The use of breast implants in irradiated patients is controversial. Recently, 39 irradiated implants were compared with 338 nonirradiated implants in 297 patients between January of 1975 and October of 1994 at The University of Texas M. D. Anderson Cancer Center. Tissue expanders and follow-up time of less than 6 months excluded patients from the study. Five groups of patients were identified. Group 1 consisted of 7 patients and 7 implants who received postoperative adjuvant radiotherapy after implant placement. Group 2 consisted of 5 patients and 7 implants who received preoperative adjuvant radiotherapy prior to implant placement. Groups 3 and 4 consisted of 2 and 12 patients (2 and 19 implants) placed beneath latissimus dorsi flaps who had postoperative and preoperative adjuvant radiotherapy, respectively. Group 5 contained 4 patients with 4 implants placed beneath a transverse rectus abdominis myocutaneous (TRAM) flap who had preoperative radiotherapy. All implants were placed submuscularly or beneath autogenous flaps. The average irradiated breast received 50 Gy. For statistical purposes, two categories were identified. Capsular contracture (Baker III or greater), pain, exposure, and implant removal in 6 of 14 implants that received radiotherapy were compared with similar complications in 33 of 266 implants without irradiation (p = 0.001). The second category contained 10 complications in 25 implants placed beneath autogenous reconstructions with radiotherapy compared with 6 of 72 similar complications in implants placed beneath autogenous reconstructions without radiotherapy (p = 0.000). Results showed that irradiation has significant negative effects on the reconstructive outcome with implants. Autogenous reconstruction did not appear to offer a protective role when placed over implants.(ABSTRACT TRUNCATED AT 250 WORDS)
在接受过放射治疗的患者中使用乳房植入物存在争议。最近，1975年1月至1994年10月期间，德克萨斯大学MD安德森癌症中心对297例患者的39个接受过放射治疗的植入物与338个未接受过放射治疗的植入物进行了比较。组织扩张器和随访时间少于6个月的患者被排除在研究之外。确定了五组患者。第一组由7例患者和7个植入物组成，这些患者在植入物放置后接受了术后辅助放疗。第二组由5例患者和7个植入物组成，这些患者在植入物放置前接受了术前辅助放疗。第三组和第四组分别由2例和12例患者（2个和19个植入物）组成，这些植入物放置在背阔肌皮瓣下方，分别接受了术后和术前辅助放疗。第五组包含4例患者和4个植入物，这些植入物放置在腹直肌横形肌皮瓣（TRAM瓣）下方，接受了术前放疗。所有植入物均放置在肌肉下或自体皮瓣下方。接受放射治疗的乳房平均剂量为50 Gy。出于统计目的，确定了两类情况。将14个接受放射治疗的植入物中有6个出现的包膜挛缩（贝克三级或更严重）、疼痛、外露和植入物取出情况与266个未接受放射治疗的植入物中有33个出现的类似并发症进行比较（p = 0.001）。第二类情况是，25个放置在接受放射治疗的自体重建下方的植入物出现了10例并发症，而72个放置在未接受放射治疗的自体重建下方的植入物中有6例出现类似并发症（p = 0.000）。结果表明，放射治疗对植入物的重建效果有显著负面影响。自体重建放置在植入物上方时似乎没有起到保护作用。（摘要截取自250字）
