Differences in breast aesthetic outcomes due to radiation: A validated, quantitative analysis of expander-implant reconstruction.

Pub Date : 2013-01-01 DOI:10.1177/229255031302100206

Lauren M Mioton, Jessica Gaido, William Small, Neil A Fine, John Y Kim

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引用次数: 10

Abstract

Background: The potential ramifications of radiation use can be of particular concern in the breast reconstruction population, in which both surgical and aesthetic outcomes are important. Presently, there remains a paucity of data detailing the influence of radiation on specific reconstruction aesthetic outcomes.

Objective: To conduct a quantitative evaluation of aesthetic outcomes for expander-implant breast reconstruction in radiated and nonradiated patients using a validated scoring scale.

Methods: A series of consecutive expander-implant breast reconstruction operations performed by the senior author between 2004 and 2012 were reviewed. Four blinded members of the Division of Plastic and Reconstructive Surgery at Northwestern University (Illinois, USA) independently rated postoperative photographs of patients' breasts using a validated scoring scale with respect to five distinct aesthetic domains.

Results: Of the 206 patients meeting the inclusion criteria, 69 received radiotherapy and 137 did not. The radiated cohort had lower scores in each aesthetic domain, with significant differences in contour (1.33 versus 1.51; P=0.041) and placement (1.45 versus 1.73; P<0.001). Linear regression analysis revealed a significant association between placement scores and radiation, and radiated patients had a significantly higher overall rate of complications.

Discussion: Variances in scores may represent the relative difficulty of expansions and proper implant placement in irradiated tissue, with possible skin fibrosis and decreased flexibility hindering prosthesis manipulation.

Conclusion: Radiation adversely impacts breast contour and placement, with possible negative contributions to volume, scarring and inframammary fold definition, and results in higher rates of complications. Such detailed evaluation of the impact of radiation on aesthetics will enhance the management of patient expectations.

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放射引起的乳房美学结果的差异:对扩张器-植入物重建的有效定量分析。

背景:在乳房重建人群中，辐射使用的潜在后果可能是一个特别关注的问题，在这个人群中，手术和美学结果都很重要。目前，仍然缺乏详细的数据，辐射对具体重建美学结果的影响。目的:采用一种有效的评分量表，对放射和非放射患者进行乳房扩张器植入重建的美学效果进行定量评价。方法:回顾资深作者2004 ~ 2012年连续进行的一系列扩张器-假体乳房重建手术。美国西北大学(Illinois, USA)整形与重建外科的四名盲眼研究人员对患者乳房的术后照片进行了独立评分，使用了一个有效的评分量表，涉及五个不同的美学领域。结果:206例符合纳入标准的患者中，69例接受放疗，137例未接受放疗。放射组在每个美学领域得分较低，在轮廓上有显著差异(1.33比1.51;P=0.041)和位置(1.45 vs 1.73;讨论:评分的差异可能代表了在辐照组织中扩张和适当植入假体的相对困难，可能的皮肤纤维化和灵活性降低阻碍了假体的操作。结论:放疗对乳房轮廓和位置有不利影响，可能对乳房体积、疤痕和乳下褶皱的定义有负面影响，并导致更高的并发症发生率。这样详细的评估放射对美学的影响将提高病人期望的管理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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