Real-world data of perioperative complications in prepectoral implant-based breast reconstruction: a prospective cohort study.

IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Archives of Gynecology and Obstetrics Pub Date : 2024-11-07 DOI:10.1007/s00404-024-07807-5
Moritz Hamann, Elena Bensmann, Anne Andrulat, Jasmin Festl, Gitti Saadat, Evelyn Klein, Dimitrios Chronas, Michael Braun
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Abstract

Purpose: To analyze complications and potential risk factors associated with immediate prepectoral direct-to-implant breast reconstruction (DTIBR).

Methods: 295 patients (326 operated breasts) with DTIBR between March 2021 and December 2023 were included in this prospective study. Postoperative complications (postoperative bleeding, seroma, infection, necrosis, wound dehiscence, implant exchange/loss) were analyzed for potential risk factors by descriptive and logistic regression analyses.

Results: The implant was covered by TiLOOP® Bra Pocket in 227 breasts (69.6%), by "dual-plane" technique in 20 breasts (6.1%), by acellular dermal matrix (ADM) in 1 breast (0.3%). No additional support was used for 78 breasts (23.9%). The use of mesh did not increase the risk for complications. Major complications requiring surgical revision occurred due to postoperative bleeding in 22 (6.7%), seroma in 2 (0.6%), infection in 13 (4.0%), necrosis in 10 (3.1%), and wound dehiscence in 10 (3.1%) breasts. Thirteen (4.0%) implants were exchanged, and 5 (1.5%) were explanted without substitution. One patient had to switch to autologous reconstruction due to skin necrosis. The main reasons for the removal/exchange of implants were infections (11 breasts, 3.4%) and necrosis (4 breasts, 1.2%). The risk for necrosis, infection, and wound dehiscence was mainly associated with the type of incision, especially skin-reducing incisions, and body mass index (BMI) ≥ 30 kg/m2.

Conclusion: Severe complications occurred primarily in patients with a BMI ≥ 30 kg/m2 and when skin-reducing surgical techniques were performed.

Trial registry: This study was retrospectively registered at the German Clinical Trials Register (DRKS) on 20.06.2024.

Drks-id: DRKS00034493. https://drks.de/search/de/trial/DRKS00034493 .

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前胸植入物乳房再造术围手术期并发症的真实数据:前瞻性队列研究。
目的:分析与胸前即刻直接植入乳房重建术(DTIBR)相关的并发症和潜在风险因素。方法:这项前瞻性研究纳入了2021年3月至2023年12月期间接受DTIBR的295名患者(326个手术乳房)。通过描述性分析和逻辑回归分析,对术后并发症(术后出血、血清肿、感染、坏死、伤口裂开、假体置换/丢失)的潜在风险因素进行了分析:227 例乳房(69.6%)使用了 TiLOOP® 胸袋覆盖假体,20 例乳房(6.1%)使用了 "双平面 "技术,1 例乳房(0.3%)使用了非细胞真皮基质(ADM)。78个乳房(23.9%)未使用额外的支撑物。使用网片不会增加并发症的风险。需要进行手术翻修的主要并发症有:22 例(6.7%)术后出血、2 例(0.6%)血清肿、13 例(4.0%)感染、10 例(3.1%)坏死、10 例(3.1%)伤口裂开。13例(4.0%)患者更换了假体,5例(1.5%)患者在未更换假体的情况下进行了手术。一名患者因皮肤坏死不得不改用自体重建。移除/更换假体的主要原因是感染(11 例乳房,3.4%)和坏死(4 例乳房,1.2%)。坏死、感染和伤口开裂的风险主要与切口类型(尤其是缩减皮肤的切口)和体重指数(BMI)≥ 30 kg/m2有关:结论:严重并发症主要发生在体重指数(BMI)≥ 30 kg/m2的患者和采用减张皮肤手术技术的患者:本研究于2024年6月20日在德国临床试验注册中心(DRKS)进行了回顾性注册:https://drks.de/search/de/trial/DRKS00034493 .
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来源期刊
CiteScore
4.70
自引率
15.40%
发文量
493
审稿时长
1 months
期刊介绍: Founded in 1870 as "Archiv für Gynaekologie", Archives of Gynecology and Obstetrics has a long and outstanding tradition. Since 1922 the journal has been the Organ of the Deutsche Gesellschaft für Gynäkologie und Geburtshilfe. "The Archives of Gynecology and Obstetrics" is circulated in over 40 countries world wide and is indexed in "PubMed/Medline" and "Science Citation Index Expanded/Journal Citation Report". The journal publishes invited and submitted reviews; peer-reviewed original articles about clinical topics and basic research as well as news and views and guidelines and position statements from all sub-specialties in gynecology and obstetrics.
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