自体脂肪移植用于全乳房重建的容积评估

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery Pub Date : 2024-09-29 DOI:10.1016/j.bjps.2024.09.083

Jamilla L.M. Wederfoort , Darius A.X. Trommelen , Mohammad Al Tarah , Juliette E. Hommes , Sander M.J. van Kuijk , René R.W.J. van der Hulst , Andrzej A. Piatkowski , for The BREAST- trial investigators

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引用次数: 0

摘要

背景整形外科医生已从使用自体脂肪移植（AFT）矫正不规则轮廓转向重建丰满乳房。虽然已有多项研究对自体脂肪移植的体积方面进行了研究，但一些结果，如体积保持率、存活率以及可能影响移植物存活率的因素仍不清楚。本研究旨在回答这些问题。方法多中心前瞻性 BREAST 试验中的乳房切除术后妇女被随机分配到 AFT 乳房重建或植入物重建 (IBR)。使用 Vectra 3D 成像系统对乳房体积进行评估，并在术后 12 个月进行比较。容积保留的定义是增大的容积除以脂肪填充容积。通过多变量回归分析确定了影响移植物存活率的重要混杂因素。结果共有 148 名患者（75 名 AFT，73 名 IBR）被纳入最终分析。术后 12 个月的容量差异显著，IBR 组更优（83.8 毫升，p < 0.001）。对于 AFT 患者，移植物存活率在 6 至 12 个月之间没有下降，12 个月时的平均移植物存活率为 37.1%。影响移植物存活率的重要混杂因素包括胸围（β = 1.107，p = 0.001）、合并症（β = 28.567，p = 0.002）、年龄（β = -0.514，p = 0.007）和总脂肪填充量（β = -0.结论整形外科医生仅使用 AFT 就能在乳房切除术后重建丰满的乳房，而且这些乳房体积在 6 个月后会趋于稳定，VECTRA 3D 是测量乳房体积的可靠工具。据计算，约有三分之一的移植脂肪在术后存活，因此整形外科医生应注意不要在一次手术中移植过多脂肪。

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Volumetric evaluation of autologous fat transfer for total breast reconstruction

Background

Reconstructive surgeons have shifted from correcting contour irregularities using autologous fat transfer (AFT) toward reconstructing full breasts. Although several studies have researched the volumetric aspects of AFT, some outcomes such as volume retention, viability, and possible confounders for graft survival, remain unclear. This study aimed to answer these questions.

Methods

Post-mastectomy women of the multicenter prospective BREAST-trial were randomized to either AFT breast reconstruction or implant-based reconstruction (IBR). Volumes were assessed using the Vectra 3D imaging system and compared at 12 months post-operative. Volume retention was defined as the augmented volume divided by the lipofilling volume. Significant confounders for graft survival were identified using multivariable regression analysis.

Results

A total of 148 patients (75 AFT, 73 IBR) were included in the final analyses. Post-operative volumes differed significantly at 12 months in favor of the IBR group (83.8 ml, p < 0.001). For AFT patients, graft survival did not decrease between 6 and 12 months, with a mean graft survival of 37.1% at 12 months. Significant confounders for graft survival included chest circumference (β = 1.107, p = 0.001), comorbidities (β = 28.567, p = 0.002), age (β = −0.514, p = 0.007), and total lipofilling (β = −0.028, p < 0.001).

Conclusion

Plastic surgeons can reconstruct voluminous breasts post-mastectomy using only AFT, and these breast volumes stabilize at 6 months and VECTRA 3D is reliable for breast volume measurement. Approximately a third of the grafted fat was calculated to survive post-operatively and reconstructive surgeons should be aware not to transfer too much fat in one session.

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来源期刊

Journal of Plastic Reconstructive and Aesthetic Surgery 医学-外科

CiteScore

3.10

自引率

11.10%

发文量

578

审稿时长

3.5 months

期刊介绍： JPRAS An International Journal of Surgical Reconstruction is one of the world''s leading international journals, covering all the reconstructive and aesthetic aspects of plastic surgery. The journal presents the latest surgical procedures with audit and outcome studies of new and established techniques in plastic surgery including: cleft lip and palate and other heads and neck surgery, hand surgery, lower limb trauma, burns, skin cancer, breast surgery and aesthetic surgery.