Gilles Houvenaeghel, Monique Cohen, Laura Sabiani, Aurore Van Troy, Olivia Quilichini, Axelle Charavil, Max Buttarelli, Sandrine Rua, Agnès Tallet, Alexandre de Nonneville, Marie Bannier
{"title":"乳房切除术和胸前或胸下植入物的即时乳房重建:评估临床实践，术后结果，患者满意度和成本。","authors":"Gilles Houvenaeghel, Monique Cohen, Laura Sabiani, Aurore Van Troy, Olivia Quilichini, Axelle Charavil, Max Buttarelli, Sandrine Rua, Agnès Tallet, Alexandre de Nonneville, Marie Bannier","doi":"10.26502/jsr.10020250","DOIUrl":null,"url":null,"abstract":"<p><p>Immediate breast reconstruction (IBR) rates increase during last years and implant-based reconstruction was the most commonly performed procedure. We examined data collected over 25 months to assess complication rate, duration of surgery, patient's satisfaction and cost, according to pre-pectoral or sub-pectoral implant-IBR. All patients who received an implant-IBR, from January 2020 to January 2022, were included. Results were compared between pre-pectoral and sub-pectoral implant-IBR in univariate and multivariate analysis. We performed 316 implant-IBR, 218 sub-pectoral and 98 (31%) pre-pectoral. Pre-pectoral implant-IBR was significantly associated with the year (2021: OR=12.08 and 2022: OR=76.6), the surgeons and type of mastectomy (SSM vs NSM: OR=0.377). Complications and complications Grade 2-3 rates were 12.9% and 10.1% for sub-pectoral implant-IBR respectively, without significant difference with pre-pectoral implant-IBR: 17.3% and 13.2%. Complications Grade 2-3 were significantly associated with age <50-years (OR=2.27), ASA-2 status (OR=3.63) and cup-size >C (OR=3.08), without difference between pre and sub-pectoral implant-IBR. Durations of surgery were significantly associated with cup-size C and >C (OR=1.72 and 2.80), with sentinel lymph-node biopsy and axillary dissection (OR=3.66 and 9.59) and with sub-pectoral implant-IBR (OR=2.088). Median hospitalization stay was 1 day, without difference between pre and sub-pectoral implant-IBR. Cost of surgery was significantly associated with cup-size > C (OR=2.216) and pre-pectoral implant-IBR (OR=8.02). Bad-medium satisfaction and IBR-failure were significantly associated with local recurrence (OR=8.820), post-mastectomy radiotherapy (OR=1.904) and sub-pectoral implant-IBR (OR=2.098).</p><p><strong>Conclusion: </strong>Complications were not different between pre and sub-pectoral implant-IBR. 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We examined data collected over 25 months to assess complication rate, duration of surgery, patient's satisfaction and cost, according to pre-pectoral or sub-pectoral implant-IBR. All patients who received an implant-IBR, from January 2020 to January 2022, were included. Results were compared between pre-pectoral and sub-pectoral implant-IBR in univariate and multivariate analysis. We performed 316 implant-IBR, 218 sub-pectoral and 98 (31%) pre-pectoral. Pre-pectoral implant-IBR was significantly associated with the year (2021: OR=12.08 and 2022: OR=76.6), the surgeons and type of mastectomy (SSM vs NSM: OR=0.377). Complications and complications Grade 2-3 rates were 12.9% and 10.1% for sub-pectoral implant-IBR respectively, without significant difference with pre-pectoral implant-IBR: 17.3% and 13.2%. Complications Grade 2-3 were significantly associated with age <50-years (OR=2.27), ASA-2 status (OR=3.63) and cup-size >C (OR=3.08), without difference between pre and sub-pectoral implant-IBR. Durations of surgery were significantly associated with cup-size C and >C (OR=1.72 and 2.80), with sentinel lymph-node biopsy and axillary dissection (OR=3.66 and 9.59) and with sub-pectoral implant-IBR (OR=2.088). Median hospitalization stay was 1 day, without difference between pre and sub-pectoral implant-IBR. Cost of surgery was significantly associated with cup-size > C (OR=2.216) and pre-pectoral implant-IBR (OR=8.02). Bad-medium satisfaction and IBR-failure were significantly associated with local recurrence (OR=8.820), post-mastectomy radiotherapy (OR=1.904) and sub-pectoral implant-IBR (OR=2.098).</p><p><strong>Conclusion: </strong>Complications were not different between pre and sub-pectoral implant-IBR. 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引用次数: 0
摘要
即时乳房重建(IBR)率在过去几年中增加，以植入物为基础的重建是最常见的手术。我们检查了超过25个月收集的数据，根据胸前或胸下植入物ibr评估并发症发生率、手术时间、患者满意度和成本。所有在2020年1月至2022年1月期间接受植入式ibr的患者均被纳入研究。结果在单因素和多因素分析中比较了胸前和胸下植入式ibr。我们进行了316例植入式ibr, 218例胸下ibr和98例(31%)胸前ibr。胸前植入物- ibr与年份(2021年:OR=12.08, 2022年:OR=76.6)、外科医生和乳房切除术类型(SSM vs NSM: OR=0.377)显著相关。胸下ibr组的并发症和并发症2-3级发生率分别为12.9%和10.1%，与胸前ibr组的17.3%和13.2%无显著差异。并发症2-3级与年龄C显著相关(OR=3.08)，胸前和胸下植入ibr无差异。手术时间与罩杯大小C和>C (OR=1.72和2.80)、前哨淋巴结活检和腋窝清扫(OR=3.66和9.59)以及胸下植入物- ibr (OR=2.088)显著相关。中位住院时间为1天，胸前和胸下植入ibr无差异。手术费用与罩杯尺寸> C (OR=2.216)和胸前植入物- ibr (OR=8.02)显著相关。不良介质满意度和ibr失败与局部复发(OR=8.820)、乳房切除术后放疗(OR=1.904)和胸下植入物- ibr (OR=2.098)显著相关。结论:胸前植入术与胸下植入术并发症无明显差异。胸前植入式ibr是一种可靠、快速的技术，患者满意度较高，但成本较高。
Mastectomy and Immediate Breast Reconstruction with Pre-Pectoral or Sub-Pectoral Implant: Assessing Clinical Practice, Post-Surgical Outcomes, Patient's Satisfaction and Cost.
Immediate breast reconstruction (IBR) rates increase during last years and implant-based reconstruction was the most commonly performed procedure. We examined data collected over 25 months to assess complication rate, duration of surgery, patient's satisfaction and cost, according to pre-pectoral or sub-pectoral implant-IBR. All patients who received an implant-IBR, from January 2020 to January 2022, were included. Results were compared between pre-pectoral and sub-pectoral implant-IBR in univariate and multivariate analysis. We performed 316 implant-IBR, 218 sub-pectoral and 98 (31%) pre-pectoral. Pre-pectoral implant-IBR was significantly associated with the year (2021: OR=12.08 and 2022: OR=76.6), the surgeons and type of mastectomy (SSM vs NSM: OR=0.377). Complications and complications Grade 2-3 rates were 12.9% and 10.1% for sub-pectoral implant-IBR respectively, without significant difference with pre-pectoral implant-IBR: 17.3% and 13.2%. Complications Grade 2-3 were significantly associated with age <50-years (OR=2.27), ASA-2 status (OR=3.63) and cup-size >C (OR=3.08), without difference between pre and sub-pectoral implant-IBR. Durations of surgery were significantly associated with cup-size C and >C (OR=1.72 and 2.80), with sentinel lymph-node biopsy and axillary dissection (OR=3.66 and 9.59) and with sub-pectoral implant-IBR (OR=2.088). Median hospitalization stay was 1 day, without difference between pre and sub-pectoral implant-IBR. Cost of surgery was significantly associated with cup-size > C (OR=2.216) and pre-pectoral implant-IBR (OR=8.02). Bad-medium satisfaction and IBR-failure were significantly associated with local recurrence (OR=8.820), post-mastectomy radiotherapy (OR=1.904) and sub-pectoral implant-IBR (OR=2.098).
Conclusion: Complications were not different between pre and sub-pectoral implant-IBR. Pre-pectoral implant-IBR seems a reliable and faster technique with better patient satisfaction but with higher cost.
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