Washington, D.C.; and Los Angeles, Calif. From the Department of Plastic Surgery, Georgetown University Hospital, and the David Geffen School of Medicine at the University of California, Los Angeles.
Plast Reconstr Surg. 2011 Mar;127(3):1047-1058. doi: 10.1097/PRS.0b013e31820436af.
BACKGROUND: Acellular dermal matrix has been increasingly accepted in prosthetic breast reconstruction. Observed benefits include improved control and support of implant position, better implant coverage, and the suggestion of a decreased capsular contracture rate. Based on this positive experience, it is not surprising that acellular dermal matrix would be applied to other challenging implant-related problems. This study investigates the use of acellular dermal matrix for correction or prevention of implant-associated breast deformities. METHODS: Patients who underwent primary aesthetic breast surgery or secondary aesthetic or reconstructive breast surgery using acellular dermal matrix and implants between November of 2003 and October of 2009 were reviewed retrospectively. Patient demographics, indications for acellular dermal matrix, and acellular dermal matrix type and inset pattern were identified. Preoperative and postoperative photographs, success or failure of the procedure, complications, and need for related or unrelated revision surgery were recorded. RESULTS: Fifty-two patients had acellular dermal matrix placed alongside 77 breast prostheses, with a mean follow-up of 8.6 months (range, 0.4 to 30.4 months). Indications included prevention of implant bottoming-out (n = 6), treatment of malposition (n = 32), rippling (n = 20), capsular contracture (n = 16), and skin flap deficiency (n = 16). Seventy-four breasts (96.1 percent) were managed successfully with acellular dermal matrix. Three failures consisted of one breast with bottoming-out following treatment of capsular contracture, one breast with major infection requiring device explantation, and one breast with recurrent rippling. There was a 9.1 percent total complication rate, consisting of three mild infections, one major infection necessitating explantation, one hematoma, and one seroma. CONCLUSION: Based on this experience in 77 breasts, acellular dermal matrix has shown promise in treating and preventing capsular contracture, rippling, implant malposition, and soft-tissue thinning.
背景：脱细胞真皮基质在假体乳房重建中越来越被接受。观察到的益处包括改善对植入物位置的控制和支撑、更好的植入物覆盖以及降低包膜挛缩率的建议。基于这种积极的经验，脱细胞真皮基质应用于其他具有挑战性的植入物相关问题也就不足为奇了。本研究调查了脱细胞真皮基质在矫正或预防与植入物相关的乳房畸形中的应用。
方法：回顾性分析 2003 年 11 月至 2009 年 10 月期间使用脱细胞真皮基质和植入物进行原发性美容乳房手术或继发性美容或重建乳房手术的患者。确定患者的人口统计学资料、脱细胞真皮基质的适应证、脱细胞真皮基质的类型和植入方式。记录术前和术后照片、手术的成败、并发症以及是否需要相关或不相关的修复手术。
结果：52 例患者共放置 77 个乳房假体，平均随访 8.6 个月（0.4 至 30.4 个月）。适应证包括预防植入物底部外露（n = 6）、矫正位置不良（n = 32）、波纹（n = 20）、包膜挛缩（n = 16）和皮瓣不足（n = 16）。74 个乳房（96.1%）通过脱细胞真皮基质成功治疗。3 例失败包括 1 例因治疗包膜挛缩导致底部外露的乳房、1 例因严重感染需要取出装置的乳房、1 例因波纹复发的乳房。总并发症发生率为 9.1%，包括 3 例轻度感染、1 例严重感染需要取出、1 例血肿和 1 例血清肿。
结论：根据 77 例乳房的经验，脱细胞真皮基质在治疗和预防包膜挛缩、波纹、植入物位置不良和软组织变薄方面显示出良好的效果。
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