University Hospital Salzburg, Breast Center Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria.
University Hospital Salzburg, Breast Center Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Institute of Pathology Graz, Medical University Graz, Graz, Austria.
J Plast Reconstr Aesthet Surg. 2015 Feb;68(2):162-7. doi: 10.1016/j.bjps.2014.10.012. Epub 2014 Oct 16.
Nipple-sparing mastectomy (NSM) and implant-based breast reconstruction are increasingly replacing conventional mastectomy for risk-reducing purposes in high-risk patients as well as for therapeutic purposes in breast cancer patients. For implant-based breast reconstruction, generally, subpectoral implant placement with partial detachment of the pectoralis major muscle (PMM) is recommended. The advantage of a potentially better cosmetic result has to be balanced with the disadvantages, such as partial injury of the PMM with subsequent muscular deficit, breast animation, and postoperative pain. We hypothesize that prepectoral implant placement and complete coverage with a porcine acellular dermal matrix (ADM) may provide an alternative to subpectoral implant placement with an excellent cosmetic result, avoiding the disadvantages of subpectoral implant placement.
In a total of 22 breasts in 13 patients (nine bilateral and four unilateral), NSM and immediate direct-to-implant breast reconstruction were performed with prepectoral implant placement. The implant was completely covered by a porcine ADM, which was sutured to the fascia of the PMM and the inframammary fold to keep the implant in place.
The cosmetic results were excellent and patients were fully satisfied at a median follow-up of 6 months. Breast animation and implant dislocation could not be observed. Implant rims were not visible, and capsular contractures grade III and IV could not be observed. The complications comprised minimal nipple necrosis in two patients and hemorrhage with evacuation in one patient.
Prepectoral implant placement and complete coverage with porcine ADM represents a novel approach and a feasible alternative to subpectoral implant placement after NSM and implant-based breast reconstruction for patients who prefer their PMM to be left intact.
为了降低高风险患者的风险以及治疗乳腺癌患者的目的，保留乳头的乳房切除术（NSM）和基于植入物的乳房重建越来越多地取代了传统的乳房切除术。对于基于植入物的乳房重建，通常建议在胸肌下植入物，并部分分离胸大肌（PMM）。潜在更好的美容效果的优势必须与缺点相平衡，例如 PMM 的部分损伤，随后出现肌肉缺陷、乳房运动和术后疼痛。我们假设，前胸部植入物的放置和使用猪脱细胞真皮基质（ADM）完全覆盖可能提供一种替代方案，与胸肌下植入物相比具有出色的美容效果，同时避免了胸肌下植入物的缺点。
在 13 名患者的 22 个乳房（9 个双侧和 4 个单侧）中，进行了 NSM 和即刻直接植入物乳房重建，采用前胸部植入物的放置。植入物完全被猪 ADM 覆盖，ADM 缝合到 PMM 的筋膜和乳晕下皱襞，以保持植入物的位置。
在中位随访 6 个月时，美容效果极佳，患者完全满意。未观察到乳房运动和植入物移位。未观察到植入物边缘，也未观察到 III 级和 IV 级包膜挛缩。并发症包括两名患者出现轻微乳头坏死和一名患者出现血肿并进行了引流。
对于希望保留胸大肌完整的患者，在前胸部植入物的放置和使用猪 ADM 完全覆盖是 NSM 和基于植入物的乳房重建后进行胸肌下植入物放置的一种新方法和可行的替代方案。
