Rochester, Minn. From Plastic and Reconstructive Surgery, Mayo Clinic.
Plast Reconstr Surg. 2013 Jul;132(1):11-18. doi: 10.1097/PRS.0b013e31829194eb.
Following mastectomy, patients may choose to have breast reconstruction with autologous tissue or implants. Human acellular dermal matrix has been described as a tissue supplement where the implant is covered, without requiring further muscle elevation or dissection. The authors evaluated the impact of different matrix sizes.
Fifty-two patients (average age, 48.5 years) and 88 operated breasts were evaluated. The cohort was divided into two, depending on matrix size. In group A, a small matrix with a surface area of 48 or 96 cm was used. In group B, a larger matrix with either 128 or 160 cm was used. Intraoperative fill volumes, expansion procedure, and complications were analyzed.
Size difference was significant (69.2 versus 135.5 cm). The calculated mean initial filling volume-to-excised pathology tissue weight ratio and the initial filling-to-final implant volume ratio were significant. Average number of fills to reach final expansion volume was 62.3 percent, or 4.7 times lower in group B. Seven complications were reported without any statistical difference between groups.
This study suggests that using a larger human acellular dermal matrix in breast reconstruction offers a potential to increase the initial expander fill volume-to-breast pathology weight ratio and initial expander fill volume-to-final implant volume ratio. Larger matrices can reduce the number of subsequent expansions and may even decrease the risk of postoperative complications. This study also revealed that using a larger matrix is a safe method that does not increase complications.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
乳房切除术后，患者可选择使用自体组织或植入物进行乳房重建。已有人体细胞外基质被描述为一种组织补充物，可在其覆盖植入物，而无需进一步提升或解剖肌肉。作者评估了不同基质大小的影响。
52 名患者（平均年龄 48.5 岁）和 88 个手术乳房进行了评估。根据基质大小将队列分为两组。在 A 组中，使用表面积为 48 或 96cm 的小基质。在 B 组中，使用表面积为 128 或 160cm 的较大基质。分析了术中填充量、扩张程序和并发症。
大小差异有统计学意义（69.2 与 135.5cm）。计算的平均初始填充体积与切除病理组织重量比和初始填充与最终植入物体积比有显著差异。达到最终扩张体积的平均填充次数为 62.3%，B 组低 4.7 倍。报告了 7 例并发症，但两组之间无统计学差异。
本研究表明，在乳房重建中使用更大的人细胞外基质可提高初始扩张器填充体积与乳房病理组织重量比和初始扩张器填充体积与最终植入物体积比。较大的基质可以减少后续扩张的次数，甚至可能降低术后并发症的风险。本研究还表明，使用更大的基质是一种安全的方法，不会增加并发症。
临床问题/证据水平：治疗性，III 级。
