Nahabedian Maurice Y, Cocilovo Costanza
Washington, DC; and Falls Church, VA.
From the Georgetown University Hospital and Inova Fairfax Hospital.
Plast Reconstr Surg. 2017 Dec;140(6S Prepectoral Breast Reconstruction):22S-30S. doi: 10.1097/PRS.0000000000004047.
Prosthetic breast reconstruction with prepectoral placement may confer clinical advantages compared with subpectoral placement. The purpose of this study was to assess and compare clinical outcomes following 2-stage reconstruction following prepectoral and partial subpectoral placement of tissue expanders and implants.
A retrospective review of 39 (prepectoral) and 50 (partial subpectoral) patients was completed. Acellular dermal matrix was used in all patients. Mean age was 50.4 and 49.2 years, respectively. Body mass index (BMI) > 30 was noted in 15.4% of prepectoral and 18% of partial subpectoral patients. Radiation therapy was delivered to 38.5% of prepectoral patients and to 22% of partial subpectoral patients. Mean follow-up was 8.7 and 13 months for the prepectoral cohort and partial subpectoral cohorts.
The percentage of patients having at least 1 adverse event was 20.5% in the prepectoral and 22% in the partial subpectoral cohorts. The incidence of surgical-site infection and seroma was 8.1% and 4.8%, respectively, for the prepectoral cohort and 4.8% and 2.4%, respectively, for the partial subpectoral cohorts. Device explantation was 6.5% for the prepectoral and 7.2% for the partial subpectoral patients. Explantation did not occur in patients who had radiation or who had a BMI > 30. Four patients (6 breasts-7.2%) required conversion from partial subpectoral to prepectoral because of animation deformity.
Prepectoral reconstruction is a viable alternative to partial subpectoral reconstruction. Proper patient selection is an important variable. Prepectoral reconstruction can be safely performed in patients with a BMI < 40 and in patients having postmastectomy radiation therapy.
与胸肌下植入相比，胸前植入进行乳房假体再造可能具有临床优势。本研究的目的是评估和比较在胸前和部分胸肌下植入组织扩张器和植入物后进行两阶段再造的临床结果。
对39例（胸前植入）和50例（部分胸肌下植入）患者进行了回顾性研究。所有患者均使用了脱细胞真皮基质。平均年龄分别为50.4岁和49.2岁。胸前植入患者中有15.4%、部分胸肌下植入患者中有18%的体重指数（BMI）>30。38.5%的胸前植入患者和22%的部分胸肌下植入患者接受了放射治疗。胸前植入队列和部分胸肌下植入队列的平均随访时间分别为8.7个月和13个月。
胸前植入队列中至少发生1次不良事件的患者百分比为20.5%，部分胸肌下植入队列中为22%。胸前植入队列的手术部位感染和血清肿发生率分别为8.1%和4.8%，部分胸肌下植入队列分别为4.8%和2.4%。胸前植入患者的装置取出率为6.5%，部分胸肌下植入患者为7.2%。接受放疗或BMI>30的患者未发生装置取出。4例患者（6侧乳房，7.2%）因动态畸形需要从部分胸肌下植入转换为胸前植入。
胸前再造是部分胸肌下再造的可行替代方案。正确的患者选择是一个重要变量。BMI<40的患者以及乳房切除术后接受放疗的患者可以安全地进行胸前再造。
