Resident, Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX.
Attending Plastic Surgeon.
Aesthet Surg J. 2020 Jan 1;40(1):53-62. doi: 10.1093/asj/sjy199.
Traditional 2-stage breast reconstruction involves placement of a textured-surface tissue expander (TTE). Recent studies have demonstrated textured surface devices have higher propensity for bacterial contamination and biofilm formation.
The purpose of this study was to evaluate the safety and efficacy of smooth surface tissue expanders (STE) in immediate breast reconstruction.
The authors retrospectively reviewed consecutive women who underwent STE breast reconstruction from 2016 to 2017 at 3 institutions. Indications and outcomes were evaluated.
A total 112 patients underwent STE reconstruction (75 subpectoral, 37 prepectoral placement), receiving 173 devices and monitored for a mean follow-up of 14.1 months. Demographics of patients included average age of 53 years and average BMI of 27.2 kg/m2, and 18.6% received postmastectomy radiation therapy. Overall complication rates were 15.6% and included mastectomy skin flap necrosis (10.4%), seroma (5.2%), expander malposition (2.9%), and infection requiring intravenous antibiotic therapy (3.5%). Six (3.5%) unplanned reoperations with explantation were reported for 3 infections and 3 patients requesting change of plan with no reconstruction.
STEs represent a safe and efficacious alternative to TTE breast reconstruction with at least equitable outcomes. Technique modification including tab fixation, strict pocket control, postoperative bra support, and suture choice may contribute to observed favorable outcomes and are reviewed. Early results for infection control and explantation rate are encouraging and warrant comparative evaluation for potential superiority over TTEs in a prospective randomized trial.
传统的两阶段乳房重建术涉及使用表面纹理的组织扩张器（TTE）。最近的研究表明，表面纹理装置更容易受到细菌污染和生物膜形成的影响。
本研究旨在评估在即刻乳房重建中使用光滑表面组织扩张器（STE）的安全性和有效性。
作者回顾性分析了 2016 年至 2017 年在 3 家机构接受 STE 乳房重建的连续女性患者。评估了适应证和结果。
共 112 例患者接受了 STE 重建（75 例胸肌下，37 例胸肌前），共植入 173 个装置，平均随访 14.1 个月。患者的人口统计学特征包括平均年龄为 53 岁，平均 BMI 为 27.2kg/m2，18.6%接受了乳腺癌根治术后放疗。总体并发症发生率为 15.6%，包括乳房切除术皮瓣坏死（10.4%）、血清肿（5.2%）、扩张器位置不当（2.9%）和需要静脉抗生素治疗的感染（3.5%）。报告了 6 例（3.5%）计划外的再手术，其中 3 例为感染，3 例为要求改变计划但不进行重建的患者。
STE 是 TTE 乳房重建的一种安全有效的替代方法，其结果至少相当。技术改良，包括钉固定、严格的口袋控制、术后胸罩支撑和缝线选择，可能有助于观察到良好的结果，并进行了回顾。感染控制和取出率的早期结果令人鼓舞，值得在前瞻性随机试验中对其潜在优于 TTE 的效果进行比较评估。
