即刻乳房重建中胸前与胸下组织扩张器置入的术后并发症:一项来自日本的回顾性研究。

IF 2.9
Ryotaro Miyano, Tomohiro Shiraishi
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引用次数: 0

摘要

背景:胸前假体置入术已成为胸下假体乳房手术中广泛采用的替代方法,可减少术后疼痛并改善美学效果。然而,在日本,产前植入硅胶乳房植入物(SBIs)仍未被批准,其临床安全性尚未得到很好的确定。方法:我们对2023年1月至2024年12月期间接受组织扩张器(TE)置入术的两期乳房重建的176例患者(187个乳房)进行了回顾性分析。患者分为胸前组(128例,135个乳房)和胸下组(48例,52个乳房)。比较术后并发症包括感染、血肿和TE暴露。进行单因素和多因素logistic回归分析以确定危险因素。结果:未发生皮肤或NAC坏死的感染在胸前组中更为常见(13.3% vs. 2.2%, p = 0.03), 17例中有14例需要侵入性治疗,10例导致TE切除或计划外自体重建。15.6%的胸前病例发生了血清瘤,而胸下病例发生了1.9% (p = 0.01), TE暴露仅发生在胸前组(4.6%)。结论:与胸下放置相比,日本患者的胸前TE放置与更高的感染、血肿和TE暴露风险相关。这些发现表明,在日本临床实践背景下,需要仔细选择患者和手术计划,在那里,术前SBI的使用尚未建立。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Postoperative complications following prepectoral versus subpectoral tissue expander placement in immediate breast reconstruction: a retrospective study from Japan.

Background: Prepectoral implant placement has become a widely adopted alternative to subpectoral reconstruction in implant-based breast surgery, offering reduced postoperative pain and improved aesthetic outcomes. However, in Japan, prepectoral placement of silicone breast implants (SBIs) remains unapproved, and its clinical safety has not been well established.

Methods: We conducted a retrospective review of 176 patients (187 breasts) who underwent immediate two-stage breast reconstruction with tissue expander (TE) placement between January 2023 and December 2024. Patients were categorized into prepectoral (128 patients, 135 breasts) and subpectoral (48 patients, 52 breasts) groups. Postoperative complications including infection, seroma, and TE exposure were compared. Univariate and multivariate logistic regression analyses were performed to identify risk factors.

Results: Infection occurring without skin or NAC necrosis was more frequent in the prepectoral group (13.3% vs. 2.2%, p = 0.03), with 14 of 17 cases requiring invasive treatment and 10 leading to TE removal or unplanned autologous reconstruction. Seroma occurred in 15.6% of prepectoral cases versus 1.9% of subpectoral (p = 0.01), and TE exposure occurred only in the prepectoral group (4.6%). Multivariate analysis identified prepectoral placement and a final fill ratio < 0.6 as independent predictors of infection. Prepectoral placement was also the sole predictor for seroma.

Conclusions: Prepectoral TE placement in Japanese patients was associated with a higher risk of infection, seroma, and TE exposure compared to subpectoral placement. These findings suggest the need for careful patient selection and surgical planning in the context of Japanese clinical practice, where prepectoral SBI use is not yet established.

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