| Objective: Compare the clinical efficacy in Immediate Latissimus Dorsi Myocutaneous Flap Reconstruction(ILDMFR)and immediate prosthesis reconstruction(IPR)in order to promote breast reconstruction into more clinical use.Method:31 cases of ILDMFR and IPR who operated by Prof.Jinsong He in the Thyroid and Breast Surgery department of Peking University Shenzhen Hospital,from January 2019 to January 2020 were enrolled in the study.11 cases in ILDMFR group and 20 cases in IPR group.1.To compared the operation cost,the incidence of postoperative complications,patient satisfaction,local recurrence rate,distant metastasis rate,overall survival rate between ILDMFR group and IPR group.2.The results were then analyzed by SPSS24.0.The mean ± standard deviation and frequency and proportion describe the qualitative data.Student t-test was conducted to investigate quantitative data between the two groups.Chi-square test was conducted to investigate qualitative data.Rank sum test was conducted to investigate rank data.Multivariate analysis was included in the Logistic regression model for factors that may be associated with complications.Significant level of P value is < 0.05.Patient satisfaction after breast reconstruction with BREAST-Q scale.Results: 1.The age of ILDMFR group is between 30 to 65 years old,the average age is(47.27 ± 10.92)years old;the age of IPR group is between 29 to 62 years old,the average age is(42.75 ± 8.42)years old.In the ILDMFR group,the operation time is between180 to 450 minutes,the average is(324.55 ± 74.61)minutes,the postoperative hospitalization time is(5-29)days,the median hospitalization time is 12(7-18)days,the operation cost is(3204~10812)RMB,and the average is(8613.27±2328.74)RMB.In the IPR group,the operation time is between120 to 240 minutes,the average is(166.00 ± 38.17)minutes,the postoperative hospitalization time is(3-22)days,the median hospitalization time is 4(3.25-7.5)days,the operation cost is(17639~39481.5)RMB,the unilateral reconstruction average cost is(20613.69±1281.96)RMB,and the bilateral reconstruction average cost is(38285.79.±902.52)RMB.2.Postoperative complications: in ILDMFR group,there is 1 case with local ischemia of the flap,1 case with seroma in the back,1 case with local infection or poor wound healing after radiotherapy.In IPR group,1 patient had rejection of prosthesis,1 patient had radiation dermatitis,3 patients had local infection or poor wound healing after radiotherapy,2 patients had capsule contracture after radiotherapy.The probability of complications in ILDMFR group and IPR group is 27.3% and 35.0%,respectively.There is no significant difference between the two methods in the overall incidence of complications(P>0.05).The age is Positively related to the incidence of complications(P=0.022),and the incidence of postoperative complications of patients receiving radiotherapy is higher than that patients without radiotherapy(P=0.004).Logistic regression model shows that postoperative radiotherapy is a relatively independent factor of complications,and postoperative radiotherapy is a risk factor of complications(P=0.013).There is no significant difference in the incidence of complications before and after radiotherapy in ILDMFR.The incidence of com Plications in IPR group with radiotherapy history is much higher than that in IPR group without radiotherapy history(P=0.001).3.Patient satisfaction evaluation: In terms of breast reconstruction satisfaction and sexual well-being,the results of latissimus dorsi group were significantly better than those of the Prosthesis group,and the difference was statistically significant(P<0.05),but the results of Physical well-being in the prosthesis group were better than those of latissimus dorsi group,and the difference of physical well-being(back and shoulder was also statistically significant(P<0.05),but the difference of physical well-being(chest)was not statistically significant(P>0.05),In terms of psychosocial well-being,the results of the two did not constitute a statistical significance(P>0.05).Compared with unilateral prosthesis reconstruction,bilateral prosthesis reconstruction can improve the patients’ breast satisfaction,sexual well-being and psychosocial well-being,and reduce the patients’ physical well-being(back and shoulder)and physical well-being(chest),but the differences of the above indexes are not statistically significant(P>0.05).4.Up to the end of this study,all patients survived and no local recurrence or distant metastasis was reported.Conclusion: For those patients who are adaptive to immediate breast reconstruction,ILDMFR and IPR are safe and feasible.Both of them have similar incidence of postoperative complications and will lead to similar social and psychological effects.ILDMFR has advantages of poor radiotherapy tolerance,lower operation cost,higher breast reconstruction satisfaction and sexual life satisfaction;IPR is a simple procedure,with advantages of shorter operation time,faster postoperative recovery and little influence on shoulder and back movement,but with poor radiotherapy tolerance,lower breast reconstruction satisfaction and sexual life satisfaction.Therefore,ILDMFR should be given priority to the patients who have the intention of reconstruction and accord with the reconstruction of latissimus dorsi myocutaneous flap. |
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