Hanna Kasandra R, DeGeorge Brent R, Mericli Alexander F, Lin Kant Y, Drake David B
Department of Plastic and Reconstructive Surgery, University of Virginia, Charlottesville, VA 22908, USA.
Ann Plast Surg. 2013 Jan;70(1):10-5. doi: 10.1097/SAP.0b013e31822f6765.
Recent reported complications have called some authors to express concern regarding the increased popularity of acellular dermal matrix (ADM)-based breast reconstruction, and its role as an alternative to traditional total submuscular approaches. To address this issue, we compared tissue expansion properties, complication rates, and patient satisfaction for both operative techniques at the same institution. A retrospective review was completed on 75 patients and 100 tissue expander/implant-based breast reconstructions at a single academic institution from 2007 to 2010. Of these cases, 31 patients were reconstructed with ADM and 44 with a submuscular coverage technique. Total complications including seroma, hematoma, infection, skin necrosis, and explantation did not significantly differ between groups (n = 13 for ADM vs. 17 for submuscular, P = 0.814). Consistent with prior reports, ADM-based reconstructions were associated with significantly increased intraoperative fill volumes and lower total number of sessions to achieve final volume. Submuscular reconstructions required a significantly higher tissue expander fill volume. Eight patients in the submuscular group required surgical revision of the breast and inframammary fold, compared with 4 in the ADM group; however, this difference was not significant. Patient satisfaction was equivalent between the 2 groups; however, it was higher in patients with bilateral reconstruction and lower among those who had received adjuvant radiation therapy. Satisfaction with nipple reconstruction was inversely proportional to time elapsed from the procedure to survey conduction. This is the first study to perform a head-to-head comparison on the basis of patient satisfaction, the results of which may be useful in preoperative planning and counseling.
近期报道的并发症使一些作者对基于脱细胞真皮基质（ADM）的乳房重建日益普及及其作为传统全肌下方法替代方案的作用表示担忧。为解决这一问题，我们在同一机构比较了两种手术技术的组织扩张特性、并发症发生率和患者满意度。对2007年至2010年在单一学术机构进行的75例患者和100例基于组织扩张器/植入物的乳房重建进行了回顾性研究。在这些病例中，31例患者采用ADM重建，44例采用肌下覆盖技术。两组间包括血清肿、血肿、感染、皮肤坏死和取出植入物在内的总并发症无显著差异（ADM组为13例，肌下组为17例，P = 0.814）。与先前报道一致，基于ADM的重建术中填充量显著增加，达到最终体积所需的总疗程数减少。肌下重建所需的组织扩张器填充量显著更高。肌下组有8例患者需要对乳房和乳房下皱襞进行手术修复，而ADM组为4例；然而，这一差异并不显著。两组患者的满意度相当；然而，双侧重建患者的满意度更高，接受辅助放疗的患者满意度较低。对乳头重建的满意度与从手术到调查进行所经过的时间成反比。这是第一项基于患者满意度进行直接比较的研究，其结果可能有助于术前规划和咨询。
