Rome, Italy From the Department of Plastic and Reconstructive Surgery and the Breast Unit, Catholic University of "Sacro Cuore," University Hospital "A. Gemelli."
Plast Reconstr Surg. 2012 Jul;130(1):31-41. doi: 10.1097/PRS.0b013e3182547d42.
The inverted-T skin-reducing mastectomy with implant reconstruction represents a very effective reconstructive and cosmetic option in patients with macromastia. However, in this subset of patients, the risk of skin flap necrosis, especially at the T-junction, is significant. In this setting, complete implant coverage with viable tissue beneath the mastectomy skin flaps is essential to reduce morbidity. In this article, the authors retrospectively review their series of 16 skin-reducing mastectomy and immediate one-stage implant reconstructions using the submuscular-subfascial pocket, analyzing the reconstructive issues and cosmetic outcomes.
Between June of 2008 and August of 2010, 14 women underwent skin-reducing mastectomy with immediate implant reconstruction using definitive anatomical gel implants, totalling 16 breasts. Reconstructive evaluation methods were clinically and photography-based assessment. The BREAST-Q was used to quantify patient satisfaction.
The average follow-up time was 18.6 months (range, 6 to 36 months). The average implant volume was 416.5 cc (range, 300 to 500 cc). The reconstructive outcomes were excellent to good, with patient satisfaction ranking high to very high, except in two patients who experienced skin necrosis (14.3 percent).
The authors' series suggests that skin-reducing mastectomy with immediate implant reconstruction can be easily and safely performed when an appropriate conservative skin-reducing mastectomy pattern is designed, providing complete autologous implant coverage with the submuscular-subfascial pocket. However, further studies are needed to enhance patient selection and reduce the complication rate.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
带假体的反 T 形皮肤缩减乳房切除术在巨乳症患者中是一种非常有效的重建和美容选择。然而，在这部分患者中，皮瓣坏死的风险，尤其是 T 形交界处，非常高。在这种情况下，通过在乳房皮瓣下覆盖完整的有活力的组织来覆盖假体对于降低发病率至关重要。本文作者回顾性分析了 16 例经肌下筋膜下袋行皮肤缩减乳房切除术和即刻一期假体重建的病例，分析了重建问题和美容效果。
2008 年 6 月至 2010 年 8 月期间，14 名女性接受了带假体的皮肤缩减乳房切除术和即刻使用定型解剖凝胶假体的重建，共涉及 16 个乳房。采用临床和摄影评估方法进行重建评估。使用 BREAST-Q 量表来量化患者满意度。
平均随访时间为 18.6 个月（6 至 36 个月）。平均植入物体积为 416.5cc（300 至 500cc）。重建效果优良，患者满意度高至非常高，除了两名患者出现皮肤坏死（14.3%）。
作者的系列研究表明，当设计出适当的保守性皮肤缩减乳房切除术模式时，带假体的即刻皮肤缩减乳房切除术可以安全且易于实施，通过肌下筋膜下袋可以为假体提供完全的自体覆盖。然而，需要进一步的研究来增强患者选择并降低并发症发生率。
临床问题/证据水平：治疗性，IV 级。
