背景:植入物和DIEP皮瓣在术后乳房感觉方面有不同的结果。与术前健康乳房相比,基于植入物的乳房重建(IBBR)对术后乳房感觉产生负面影响。然而,目前尚不清楚之前的IBBR是否也会影响替换DIEP皮瓣的术后感觉.这项队列研究的目的是评估IBBR对替换DIEP皮瓣的术后感觉的影响。
方法:如果女性在乳房切除术后接受了DIEP皮瓣重建,有或没有事先组织扩张器(TE)和/或明确的乳房植入物。用Semmes-Weinstein单丝在乳房的9个区域以四个间隔测量感觉:T0(术前,植入/无重建),T1(术后2-7个月,DIEP),T2(术后±12个月,DIEP),Tmax(最大随访,DIEP)。线性混合效应模型用于研究DIEP皮瓣之前的植入物/TE与乳房感觉恢复之间的关系。
结果:142名女性包括206名乳房。48(23.3%)乳房,和158(76.7%)乳房在DIEP之前没有TE/IBBR。在先前的植入/TE与皮瓣皮肤的DIEP皮瓣乳房感觉恢复之间没有发现统计学上的显着或临床相关关系,原生皮肤,或在T1、T2或Tmax时的总乳房皮肤。在调整混杂因素放射治疗后也没有发现任何关系,BMI,糖尿病,年龄,皮瓣重量,后续行动,和神经接合。
结论:在DIEP皮瓣之前植入/TE不会影响DIEP皮瓣术后乳房感觉的恢复。
BACKGROUND: Implants and DIEP flaps have different outcomes regarding postoperative breast sensation. When compared to the preoperative healthy breast, implant-based breast reconstruction (IBBR) negatively influences postoperative breast sensation. However, it is currently unknown whether a prior IBBR also influences postoperative sensation of a replacing DIEP flap. The goal of this cohort study is to evaluate the influence of an IBBR on the postoperative sensation of a replacing DIEP flap.
METHODS: Women were included if they received a DIEP flap reconstruction after mastectomy, with or without prior tissue expander (TE) and/or definitive breast implant. Sensation was measured at four intervals in 9 areas of the breast with Semmes-Weinstein monofilaments: T0 (preoperative, implant/no reconstruction), T1 (2-7 months postoperative, DIEP), T2 (± 12 months postoperative, DIEP), Tmax (maximum follow-up, DIEP). Linear mixed-effects models were used to investigate the relationship between an implant/TE prior to the DIEP flap and recovery of breast sensation.
RESULTS: 142 women comprising 206 breasts were included. 48 (23.3%) breasts did, and 158 (76.7%) breasts did not have a TE/IBBR prior to their DIEP. No statistically significant or clinically relevant relationships were found between a prior implant/TE and recovery of DIEP flap breast sensation for the flap skin, native skin, or total breast skin at T1, T2, or Tmax. There were also no relationships found after adjustment for the confounders radiation therapy, BMI, diabetes, age, flap weight, follow-up, and nerve coaptation.
CONCLUSIONS: An implant/TE prior to a DIEP flap does not influence the recovery of postoperative breast sensation of the DIEP flap.