Becker Hilton, Zhadan Olga
Hilton Becker Clinic of Plastic Surgery, Boca Raton, Fla.
Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Fla.
Plast Reconstr Surg Glob Open. 2018 Jul 13;6(7):e1865. doi: 10.1097/GOX.0000000000001865. eCollection 2018 Jul.
Skin expansion is commonly needed in order to reconstruct the breast following modified radical mastectomy. With the advent of skin-sparing and nipple-sparing techniques, expansion is no longer necessary. The natural ability of healing tissues to contract can be advantageously used to improve the outcomes of immediate prepectoral breast reconstruction.
A prospective analysis of the results of 20 prepectoral breast reconstructions following skin-sparing or nipple-sparing mastectomies was performed. Reconstruction was performed using the adjustable breast implant initially underfilled with air. No acellular dermal matrix or mesh support was used. Further air was added during the follow-up office visits. Air was replaced with normal saline when the desired breast size was achieved. The adjustable implants were replaced with silicone gel implants when necessary.
Contraction of the skin flap over the underfilled implant was noticed in all patients. Five patients (25%) developed a seroma, and 2 patients had hematoma of the breast pocket. Wound-edge necrosis required debridement in 2 patients (10%). Complications were all resolved without implant loss.
Tissue contraction can be successfully utilized in breast reconstruction following skin-sparing and nipple-sparing mastectomy. Contraction results in thickening and elevation of the flap, eliminating the need for skin excision or the use of acellular dermal matrix. The partially filled implant functions as a spacer, preventing the flap from adhering to the underlying muscle and avoiding pressure on the skin flap.
在改良根治性乳房切除术后进行乳房重建时，通常需要进行皮肤扩张。随着保乳和保留乳头技术的出现，扩张不再必要。愈合组织自然的收缩能力可被有利地用于改善即刻胸前乳房重建的效果。
对20例保乳或保留乳头乳房切除术后的胸前乳房重建结果进行前瞻性分析。重建使用初始充入空气的可调节乳房植入物。未使用无细胞真皮基质或网状支撑物。在随访门诊就诊期间进一步充入空气。当达到所需乳房大小时，将空气替换为生理盐水。必要时将可调节植入物更换为硅胶凝胶植入物。
所有患者均注意到未充分填充的植入物上方皮瓣的收缩。5例患者（25%）出现血清肿，2例患者乳房腔隙出现血肿。2例患者（10%）伤口边缘坏死需要清创。所有并发症均得以解决，未发生植入物丢失。
在保乳和保留乳头乳房切除术后的乳房重建中，组织收缩可被成功利用。收缩导致皮瓣增厚和抬高，无需进行皮肤切除或使用无细胞真皮基质。部分填充的植入物起到间隔物的作用，防止皮瓣与下方肌肉粘连，并避免对皮瓣施加压力。
