Onesti Maria Giuseppina, Maruccia Michele, Di Taranto Giuseppe, Albano Antonio, Soda Giuseppe, Ballesio Laura, Scuderi Nicolò
Department Surgery "P.Valdoni", Unit of Plastic and Reconstructive Surgery, Sapienza University, Rome, Italy.
Department Surgery "P.Valdoni", Unit of Plastic and Reconstructive Surgery, Sapienza University, Rome, Italy.
J Plast Reconstr Aesthet Surg. 2017 Nov;70(11):1527-1536. doi: 10.1016/j.bjps.2017.06.023. Epub 2017 Jun 29.
Prepectoral implant placement and complete coverage with porcine acellular matrix after mastectomy is a new concept in breast surgery presented in few cases in the literature. This paper aimed to present our single-center experience in one-stage breast reconstruction muscle-sparing "wrap" technique by evaluating clinical and aesthetic outcomes, ultrasound and histological examination, and patient quality of life.
From January 2014 to January 2017, 52 patients (40 unilateral, 12 bilateral) underwent one-stage muscle-sparing breast reconstructions with Braxon acellular dermal matrix and implant. In 3 patients, a surgical biopsy and histological examination with immunohistochemical analysis of the periprosthetic tissue were performed. All patients underwent breast ultrasound examination, and the occurrence of capsular contracture was assessed through the Baker classification and by measuring the mammary compliance scores with the Antoon Paar Mammary compliance system. Breast appearance was evaluated using a visual analogue scale (VAS) and in terms of quality of life using the EOCRT QLQ C-30 and QLQ BR-23 questionnaires.
Early and late postoperative complications are reported. Histological and ultrasound evaluation showed a complete integration of the matrix. According to the VAS scale, the EOCRT QLQ C-30, and QLQ BR-23, patients' satisfaction resulted in a high score in terms of quality of life and aesthetic outcomes.
The results of this new surgical technique in selected cases are promising in terms of effectiveness and low rate of postoperative complications, but further long-terms evaluations are required.
乳房切除术后在胸大肌前植入假体并使用猪脱细胞基质进行完全覆盖是乳房手术中的一个新概念,文献中仅有少数病例报道。本文旨在通过评估临床和美学效果、超声及组织学检查以及患者生活质量,介绍我们单中心采用保留肌肉的“包裹”技术进行一期乳房重建的经验。
2014年1月至2017年1月,52例患者(40例单侧,12例双侧)接受了使用Braxon脱细胞真皮基质和假体的一期保留肌肉的乳房重建手术。对3例患者进行了手术活检,并对假体周围组织进行了组织学检查及免疫组化分析。所有患者均接受了乳房超声检查,并通过Baker分级以及使用安东帕乳房顺应性系统测量乳房顺应性评分来评估包膜挛缩的发生情况。使用视觉模拟量表(VAS)评估乳房外观,并使用欧洲癌症研究与治疗组织生活质量问卷C-30和QLQ BR-23评估生活质量。
报告了术后早期和晚期并发症。组织学和超声评估显示基质完全整合。根据VAS量表、欧洲癌症研究与治疗组织生活质量问卷C-30和QLQ BR-23,患者在生活质量和美学效果方面的满意度得分较高。
这种新手术技术在特定病例中的结果在有效性和低术后并发症发生率方面很有前景,但需要进一步的长期评估。