McCarthy Colleen M, VanLaeken Nancy, Lennox Peter, Scott Amie M, Pusic Andrea L
Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, USA.
Eplasty. 2010 Jan 4;10:e7.
Various techniques have been used in an attempt to achieve long-term nipple projection following nipple-areolar reconstruction. A common setback, however, is the diminution of projection overtime; this phenomenon is particularly evident following implant-based breast reconstruction. Artecoll may be suitable for injection into the nipple complex to maintain permanent, 3-dimensional projection. Artecoll is an injectable substance that is biocompatible and immunologically inert and resists degradation in vivo. The purpose of this study was thus to prospectively evaluate the efficacy of Artecoll (polymethylmethacrylate microspheres suspended in 3.5% denatured bovine collagen with 0.3% lidocaine) in obtaining and maintaining nipple projection following postmastectomy, nipple-areolar reconstruction.
A prospective, clinical trial was performed. Consecutive patients deemed to have inadequate nipple projection at least 6 months following "C-V flap" or "modified-skate flap" reconstruction were identified. Only women who had postmastectomy reconstruction with tissue expanders and implants were considered eligible for participation. Artecoll was injected under the nipple at 2 time points: baseline and 3 months. Calipers were used to measure nipple projection preinjection and postinjection at baseline, 3, 6, and 9 months.
Thirty-three nipples were injected in 23 patients. There were no adverse events. Prior to injection, mean nipple projection was 1.33 +/- 1.0 mm. The mean increase in projection over the 9-month study period was both clinically and statistically significant (1.60 +/- 1.24 mm; P <.001). A history of prior irradiation was a significant negative predictor of final nipple projection (P = .012).
Artecoll injection is both feasible and effective in increasing and maintaining nipple projection in the setting of implant-based breast reconstruction.
为了在乳头乳晕重建后实现长期的乳头突出，人们采用了各种技术。然而，一个常见的问题是随着时间的推移乳头突出会逐渐减小；这种现象在基于植入物的乳房重建后尤为明显。爱贝芙可能适用于注入乳头复合体以维持永久性的三维突出。爱贝芙是一种可注射物质，具有生物相容性且免疫惰性，在体内抗降解。因此，本研究的目的是前瞻性评估爱贝芙（悬浮于含0.3%利多卡因的3.5%变性牛胶原蛋白中的聚甲基丙烯酸甲酯微球）在乳房切除术后乳头乳晕重建后获得并维持乳头突出的疗效。
进行了一项前瞻性临床试验。确定了在“C-V皮瓣”或“改良滑板皮瓣”重建后至少6个月乳头突出不足的连续患者。仅考虑接受组织扩张器和植入物进行乳房切除术后重建的女性有资格参与。在两个时间点将爱贝芙注入乳头下方：基线时和3个月时。使用卡尺在基线、3、6和9个月时测量注射前和注射后的乳头突出。
23例患者的33个乳头接受了注射。未发生不良事件。注射前，平均乳头突出为1.33±1.0毫米。在9个月的研究期间，突出的平均增加在临床和统计学上均具有显著意义（1.60±1.24毫米；P<.001）。既往有放疗史是最终乳头突出的显著负性预测因素（P = .012）。
在基于植入物的乳房重建中，注射爱贝芙在增加和维持乳头突出方面既可行又有效。
