Washington, D.C. From the Department of Plastic Surgery, Georgetown University Hospital.
Plast Reconstr Surg. 2012 Nov;130(5 Suppl 2):89S-94S. doi: 10.1097/PRS.0b013e3182625852.
Prosthetic-based breast reconstruction commonly involves device placement in either a total submuscular pocket or a partial subpectoral position for just superior pole coverage, with various possible strategies for inferior pole coverage. Historically, the pectoralis major muscle is managed either by suturing the muscle to the inferior flap or with marionette sutures; alternatively, the device is placed under total muscle/fascia coverage (under the pectoralis major, plus the serratus anterior and rectus abdominis muscles or fascia). For many plastic surgeons, acellular dermal matrix is now used instead to function as a sling or "hammock" supporting the periprosthetic pocket and thus covering the inferior pole of the device, attached to the pectoralis major muscle above and to the inframammary fold below. In addition to its added soft-tissue support in the inferior pole, acellular dermal matrix may help to stabilize the pectoralis major muscle along its inferolateral margin, create a well-defined inframammary fold, provide the opportunity to significantly increase intraoperative fill volume of the tissue expander, and reduce the incidence or severity of significant or symptomatic capsular contracture, particularly in a patient whose breast has been treated with radiation. In addition to its indications in primary breast reconstruction, acellular dermal matrix has been increasingly used in secondary revision reconstruction cases. It can be used to buttress capsulorrhapy and capsulotomy sites and it can be used to replace periprosthetic capsule following capsulectomy. While clinical experience is accruing for these indications, acellular dermal matrix continues to be used in primary and secondary breast reconstruction.
基于假体的乳房重建通常涉及将器械放置在全肌下袋或部分胸肌下位置，仅覆盖上极，对于下极覆盖有各种可能的策略。历史上，胸大肌要么通过将肌肉缝合到下皮瓣上来处理，要么通过使用人偶缝线来处理；或者，将器械放置在全肌肉/筋膜覆盖下（在胸大肌下，加上前锯肌和腹直肌或筋膜）。对于许多整形外科医生来说，现在使用脱细胞真皮基质来作为吊带或“吊床”，以支撑假体周围的口袋，从而覆盖器械的下极，固定在胸大肌上方和乳房下皱襞下方。除了在下极提供额外的软组织支撑外，脱细胞真皮基质还可以帮助稳定胸大肌沿其下外侧边缘，形成明确的乳房下皱襞，提供显著增加组织扩张器术中填充体积的机会，并降低显著或有症状的包膜挛缩的发生率或严重程度，特别是在乳房接受过放疗的患者中。除了在原发性乳房重建中的适应证外，脱细胞真皮基质在继发性修复重建病例中的使用也越来越多。它可以用于支撑囊切开术和囊切开术部位，并且可以在囊切除术之后用于替代假体周围的包膜。虽然这些适应证的临床经验正在积累，但脱细胞真皮基质仍在原发性和继发性乳房重建中使用。
