Kornstein Andrew
Museum Mile Surgery Center, 1050 Fifth Avenue, New York, NY 10028, USA.
J Med Case Rep. 2013 Dec 30;7:275. doi: 10.1186/1752-1947-7-275.
Patients who present for augmentation mammoplasty with poor quality mammary soft-tissue support may be at increased risk for post-operative complications. Non-crosslinked intact porcine-derived acellular dermal matrix (Strattice™ Reconstructive Tissue Matrix, LifeCell Corp., Branchburg, NJ, USA) may enhance soft-tissue support in such patients and reduce implant-related complications, including capsular contracture, rippling, palpability, and malposition. The objective of this case report series was to describe the outcomes of three patients with poor quality mammary soft-tissue support who underwent primary cosmetic breast augmentation with pre-emptive implantation of porcine-derived acellular dermal matrix.
Case 1 concerns a 40-year-old Caucasian woman with post-partum soft tissue laxity and grade II ptosis. Case 2 concerns a 30-year-old Caucasian woman with congenital soft-tissue laxity and grade I + ptosis. Case 3 concerns a 49-year-old Caucasian woman with post-partum and post-weight-loss-induced laxity and grade III ptosis. In all three of our patients, porcine-derived acellular dermal matrix was sutured to the chest wall along the infra-mammary and/or a neo-infra-mammary fold and then laid passively superiorly or sutured under tension to the breast parenchyma or caudal edge of the pectoralis major muscle. In cases 1 and 2, a modified internal mastopexy technique was performed. Suturing the porcine-derived acellular dermal matrix to the posterior aspect of the breast parenchyma and/or caudal pectoralis muscle under appropriate tension in conjunction with radial plication of the porcine-derived acellular dermal matrix created a snug 'hand-in-glove' pocket and resulted in only minimal peri-areolar scarring. Case 3 required a vertical scar mastopexy. During a mean of 18 months of follow-up, all three patients had positive outcomes and no complications (that is, infection, hematoma, seroma, rippling, malposition, or capsular contracture). The surgeon and patients were generally highly satisfied with the aesthetic outcome of the breasts.
Pre-emptive use of porcine-derived acellular dermal matrix may be beneficial in patients with primary augmentation with poor quality mammary soft-tissue support.
因乳腺软组织支撑力差而接受隆乳术的患者术后并发症风险可能会增加。非交联完整猪源脱细胞真皮基质（Strattice™ 重建组织基质，美国新泽西州布兰奇堡的LifeCell公司）可能会增强这类患者的软组织支撑力，并减少与植入物相关的并发症，包括包膜挛缩、波纹、可触及性和位置异常。本病例报告系列的目的是描述三名乳腺软组织支撑力差的患者在进行初次美容隆乳术时预先植入猪源脱细胞真皮基质的结果。
病例1为一名40岁的白人女性，有产后软组织松弛和II级乳房下垂。病例2为一名30岁的白人女性，有先天性软组织松弛和I +级乳房下垂。病例3为一名49岁的白人女性，有产后和减肥后引起的松弛以及III级乳房下垂。在我们所有三名患者中，猪源脱细胞真皮基质沿着乳房下和/或新乳房下皱襞缝合到胸壁，然后被动地向上放置或在张力下缝合到乳腺实质或胸大肌的下缘。在病例1和病例2中，采用了改良的内部乳房上提术。在适当的张力下将猪源脱细胞真皮基质缝合到乳腺实质的后侧和/或胸大肌的下缘，并结合猪源脱细胞真皮基质的放射状折叠，形成了一个贴合的“手套式”腔隙，且乳晕周围仅留下极少的疤痕。病例3需要进行垂直疤痕乳房上提术。在平均18个月的随访期间，所有三名患者均取得了良好的效果，且无并发症（即感染、血肿、血清肿、波纹、位置异常或包膜挛缩）。外科医生和患者对乳房的美学效果总体上非常满意。
对于乳腺软组织支撑力差的初次隆乳患者，预先使用猪源脱细胞真皮基质可能有益。
