Jones Glyn, Yoo Aran, King Victor, Jao Brian, Wang Huaping, Rammos Charalambos, Elwood Eric
Peoria, Ill.; and Boston, Mass.
From the University of Illinois College of Medicine; University of Massachusetts; and Illinois Plastic Surgery.
Plast Reconstr Surg. 2017 Dec;140(6S Prepectoral Breast Reconstruction):31S-38S. doi: 10.1097/PRS.0000000000004048.
Staged subpectoral expander-implant breast reconstruction is widely performed. Disruption of the pectoralis major origin and the frequent occurrence of animation deformity and functional discomfort associated with subpectoral reconstruction remain ongoing concerns. Prepectoral single-stage direct-to-implant reconstruction resolves many of these issues. In this study, the authors explored the rationale for prepectoral single-stage implant-based breast reconstruction with anterior AlloDerm coverage as an alternative to the staged approach.
Seventy-three breasts in 50 patients were reconstructed using a single-stage direct-to-implant prepectoral approach with total anterior AlloDerm coverage during a 24-month period. The decision to proceed with single-stage reconstruction was predicated upon the adequacy of mastectomy skin flap blood flow based on indocyanine green fluorescence perfusion assessment. The patients were followed up for a maximum of 32 months.
Ninety-seven percent of patients achieved complete healing within 8 weeks. There were 2 implant losses (2.7%) due to infection. Major seroma rate requiring repeated aspiration and drain insertion was 1.2%. There were no full-thickness skin losses. Capsular contracture was 0% in nonradiated patients. There were no cases of animation deformity. The authors were unable to establish significant correlation between complications and any of the usually stated risk factors, such as smoking, obesity, and large mastectomy weights, presumably due to the rigorous application of intraoperative skin perfusion assessment.
Single-stage direct-to-implant reconstruction using a prepectoral approach appears to be a safe and effective means of breast reconstruction in many patients, assuming adequate skin perfusion is present.
分期的胸大肌下扩张器-植入物乳房重建术应用广泛。胸大肌起点的破坏以及与胸大肌下重建相关的动态畸形和功能不适的频繁发生仍是持续存在的问题。胸肌前单阶段直接植入重建解决了其中许多问题。在本研究中，作者探讨了采用胸肌前单阶段植入物乳房重建并覆盖前部同种异体真皮作为分期方法替代方案的理论依据。
在24个月期间，对50例患者的73个乳房采用胸肌前单阶段直接植入方法进行重建，并完全覆盖前部同种异体真皮。基于吲哚菁绿荧光灌注评估，根据乳房切除皮瓣血流是否充足来决定是否进行单阶段重建。对患者进行了最长32个月的随访。
97%的患者在8周内实现完全愈合。有2例（2.7%）因感染导致植入物丢失。需要反复抽吸和插入引流管的主要血清肿发生率为1.2%。没有全层皮肤损失。未接受放疗的患者包膜挛缩率为0%。没有出现动态畸形病例。作者无法确定并发症与任何通常所述的风险因素（如吸烟、肥胖和乳房切除重量较大）之间存在显著相关性，可能是由于术中严格应用了皮肤灌注评估。
假设存在足够的皮肤灌注，采用胸肌前方法进行单阶段直接植入重建似乎是许多患者乳房重建的一种安全有效的方法。
