Division of Plastic and Reconstructive Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo St. Suite 415, Los Angeles, CA 90033, USA.
J Plast Reconstr Aesthet Surg. 2011 Dec;64(12):1553-61. doi: 10.1016/j.bjps.2011.02.001. Epub 2011 Mar 8.
The use of acellular dermal matrix (ADM) in implant based breast reconstruction has become increasingly popular to the point that a subset of surgeons use ADM for virtually every tissue expander/implant based reconstruction. While there may be a number of perceived and anecdotal advantages such as decreased post-operative pain, increased initial expander fill volume, and improved aesthetic outcome, it remains unclear as to whether there is sufficient evidence to support these as well as other claims or its routine use. In this review, we identified all papers in the PubMed and Medline databases that addressed outcomes of the use of ADM in single and multiple staged implant based breast reconstruction. Papers were evaluated for any claim of benefit in using ADM in breast reconstruction. The following perceived advantages were supported solely by anecdotal reports and opinions: reduction in post-op pain, decreased operative time, precise control of the lateral and IMF, maximal use of mastectomy skin flaps, and improved lower pole expansion. There was inconsistent data for commonly perceived advantages, such as: eliminating the need for expanders, increased initial fill volumes, fewer expansions, faster time to reconstruction completion, decreased rate of revision, and improved aesthetic outcome. We found consistent support for a decreased incidence of capsular contracture; however the existing reports have limited long term follow-up. Despite the many heralded benefits of ADM in breast reconstruction, the data supporting these claims is mostly anecdotal. Both long term outcomes and randomized controlled prospective studies are needed in order to definitively evaluate the perceived advantages of ADM in breast reconstruction.
脱细胞真皮基质 (ADM) 在基于植入物的乳房重建中的应用越来越受欢迎，以至于有一部分外科医生几乎将 ADM 用于所有组织扩张器/基于植入物的重建。虽然可能有许多被认为和传闻中的优势，如减少术后疼痛、增加初始扩张器填充量和改善美学效果，但尚不清楚是否有足够的证据支持这些以及其他声称或其常规使用。在这篇综述中，我们在 PubMed 和 Medline 数据库中确定了所有涉及 ADM 在单阶段和多阶段基于植入物的乳房重建中应用结果的论文。这些论文评估了在乳房重建中使用 ADM 的任何获益声明。以下被认为的优势仅基于传闻和意见：减少术后疼痛、减少手术时间、精确控制侧方和 IMF、最大限度地利用乳房切除术皮瓣和改善下极扩张。对于常见的优势，如：消除对扩张器的需求、增加初始填充量、减少扩张次数、更快完成重建时间、减少修复率和改善美学效果，数据不一致。我们发现包膜挛缩发生率降低的一致性支持；然而，现有的报告具有有限的长期随访。尽管 ADM 在乳房重建中有许多被称赞的益处，但支持这些说法的数据主要是传闻。为了明确评估 ADM 在乳房重建中的被认为的优势，需要长期结果和随机对照前瞻性研究。
