Sigalove Steven
Warrenville, Ill.
From the Institute of Aesthetic Plastic Surgery and Cantera Spa.
Plast Reconstr Surg. 2017 Dec;140(6S Prepectoral Breast Reconstruction):39S-42S. doi: 10.1097/PRS.0000000000004049.
Prepectoral prosthetic breast reconstruction has become increasingly popular during the last several years. Original shortcomings and poor outcomes in the 1970s have been overcome with the use of the bioengineered breast concept-namely, use of improved form stable breast implants, autologous fat grafting, and acellular dermal matrices (ADMs). Careful use of these reconstructive tools combined with improved mastectomy skin flaps has lead to successful early outcomes. Prepectoral breast reconstruction mitigates the animation deformities and muscle tightness previously associated with dual-plane prosthetic breast reconstruction while at the same time producing reproducible and outstanding aesthetic outcomes. The use of ADM is a critical component to performing prepectoral breast reconstruction. There are many techniques utilized to inset the ADM. Various methods of direct in vivo inset have been performed. These techniques are employed following completion of the mastectomy and are performed with both 2-stage as well as single-stage direct-to-implant reconstruction. Various ex vivo techniques have also been used for prepectoral breast reconstruction. Various prefabricated constructs of ADM and implant/tissue expander can be created on the back table while the mastectomy is in progress, which decreases operative time and improves surgical efficiency. This article will describe briefly the history of prepectoral reconstruction as well as describing the various techniques used for creating the ADM-device interphase.
在过去几年中，胸肌前假体乳房重建越来越受欢迎。20世纪70年代的原始缺点和不佳效果已通过生物工程乳房概念的应用得以克服，即使用改良的形态稳定乳房植入物、自体脂肪移植和脱细胞真皮基质（ADM）。谨慎使用这些重建工具并结合改良的乳房切除皮瓣，已取得了成功的早期效果。胸肌前乳房重建减轻了先前与双平面假体乳房重建相关的动态畸形和肌肉紧绷，同时产生了可重复且出色的美学效果。ADM的使用是进行胸肌前乳房重建的关键组成部分。有许多技术用于植入ADM。已进行了各种直接体内植入的方法。这些技术在乳房切除完成后采用，可用于两阶段以及单阶段直接植入式重建。各种体外技术也已用于胸肌前乳房重建。在进行乳房切除时，可以在手术台上制作各种预制的ADM与植入物/组织扩张器的组合体，这减少了手术时间并提高了手术效率。本文将简要介绍胸肌前重建的历史，并描述用于创建ADM - 装置界面的各种技术。
