New York, N.Y. From the Division of Plastic Surgery, New York Medical College.
Plast Reconstr Surg. 2012 Nov;130(5 Suppl 2):95S-103S. doi: 10.1097/PRS.0b013e318262e1a1.
Direct-to-implant reconstruction with acellular dermal matrix has expanded the surgeon's repertoire and given the patient an opportunity to have a one-stage option after skin- or nipple-sparing mastectomy. The technique produces total implant coverage without the need for expansion, repeated operations, and delayed return of normal body image.
In patients with adequate, good-quality mastectomy skin, a subpectoral pocket is created after mastectomy. The inferomedial pectoralis major muscle is elevated for implant placement. The acellular dermal matrix is sutured to the released inferior pole of the pectoralis muscle along its entire lower course and to the lateral mammary fold. The implant is introduced beneath the muscle-matrix layer, and the matrix is sutured to the inframammary fold at its desired position. Two suction drains are placed, one subpectorally and the other subcutaneously, through separate stab incisions, followed by skin closure.
Over a 10-year period, the author has performed this technique in 439 patients (790 breasts). Consistently low complication rates and good aesthetic outcomes have been obtained. Major complications, including implant loss (1.6 percent), skin necrosis requiring reoperation (1.3 percent), infection (1.1 percent), hematoma (0.6 percent), seroma (0.5 percent), and capsular contracture (0.5 percent), have remained at an incidence of less than 2 percent.
The author's 10-year results using acellular dermal matrix in direct-to-implant breast reconstructions demonstrate the effectiveness of the procedure, as well as its long-term safety and aesthetic benefits. Its success, however, relies on appropriate patient selection and specific intraoperative technique principles.
脱细胞真皮基质的直接植入重建扩大了外科医生的手术范围，使患者在接受保乳或乳头保留乳房切除术（skin-sparing mastectomy，SSM）后有机会选择一期重建。该技术可实现完全的假体覆盖，无需扩张、重复手术和延迟恢复正常的身体形象。
在具有足够、高质量乳房皮肤的患者中，在乳房切除术后创建胸肌下口袋。提起胸大肌的中下内缘以放置植入物。将脱细胞真皮基质缝合到胸大肌释放的下极，沿着其整个下行程缝合，并缝合到乳房下皱襞。将植入物引入肌肉-基质层下，然后将基质缝合到期望位置的乳晕下皱襞。通过两个单独的刺切口放置两个引流管，一个位于胸肌下，另一个位于皮下，然后进行皮肤闭合。
在 10 年期间，作者在 439 名患者（790 只乳房）中进行了该技术。始终获得较低的并发症发生率和良好的美学效果。重大并发症，包括植入物丢失（1.6%）、需要再次手术的皮肤坏死（1.3%）、感染（1.1%）、血肿（0.6%）、血清肿（0.5%）和包膜挛缩（0.5%）的发生率保持在 2%以下。
作者在直接植入乳房重建中使用脱细胞真皮基质 10 年的结果证明了该手术的有效性，以及其长期的安全性和美学效果。然而，其成功依赖于合适的患者选择和特定的术中技术原则。
