Bonomi Stefano, Sala Laura, Gennaro Massimiliano, Ricci Cristian, Cortinovis Umberto
From the Plastic and Reconstructive Surgery Unit, and.
Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Ann Plast Surg. 2019 Jan;82(1):19-27. doi: 10.1097/SAP.0000000000001614.
Despite skin-sparing mastectomy techniques have significantly improved reconstructive options and aesthetic outcomes, patients with large and ptotic breasts remain a challenging group to treat satisfactorily. The Wise-pattern skin-reducing mastectomy (SRM) has been designed for this kind of patients but is not without morbidity. To improve safety, the authors reviewed their experience with a modified SRM and immediate 1-stage implant-based breast reconstruction, using a synthetic absorbable mesh combined with a dermal flap.
A retrospective review was undertaken to identify women with medium to large ptotic breast and medium minimally ptotic breast who had undergone SRM and direct-to-implant breast reconstruction using definitive anatomical gel implant, de-epithelialized dermal flap, and absorbable synthetic mesh, between October 2014 and December 2016. Patient demographics were queried, and complication rates, aesthetic outcomes, and patients satisfaction were assessed.
Sixty-two procedures of SRM were performed in 56 patients. Forty-five women received contralateral symmetrization. Twenty-one overall complications occurred in 16 patients. Statistical correlation between risk factors and complications onset was assessed. Body mass index resulted the most substantial risk factor (P = 0.0028) for developing complications, whereas preoperative chemotherapy (P = 0.0050) and comorbidities (P = 0.0117) played a decent role. Smoking attitude (P = 0.1122), age (P = 0.9990), and implant weight (P = 0.1583) did not result as significant risk factors. The reconstructive outcomes were good to excellent in 92.8%, with patient satisfaction ranking very to highly satisfied in 84%.
The authors' series suggests that SRM with direct-to-implant breast reconstruction can be easily performed when an appropriate SRM pattern is designed, providing complete implant coverage with submuscular-dermal-mesh pocket.
尽管保留皮肤的乳房切除术技术显著改善了重建选择和美学效果，但乳房较大且下垂的患者仍是难以令人满意地治疗的群体。 Wise模式皮肤缩减乳房切除术（SRM）就是针对这类患者设计的，但并非没有并发症。为提高安全性，作者回顾了他们使用合成可吸收网片联合真皮瓣进行改良SRM及一期即刻乳房假体植入重建的经验。
进行一项回顾性研究，以确定在2014年10月至2016年12月期间接受SRM及使用定型解剖型凝胶假体、去上皮真皮瓣和可吸收合成网片进行直接乳房假体植入重建的中至重度乳房下垂及中度轻度乳房下垂的女性。查询患者人口统计学资料，并评估并发症发生率、美学效果和患者满意度。
56例患者共进行了62例SRM手术。45名女性接受了对侧对称手术。16例患者共发生21例并发症。评估了危险因素与并发症发生之间的统计学相关性。体重指数是发生并发症的最主要危险因素（P = 0.0028），而术前化疗（P = 0.0050）和合并症（P = 0.0117）也起了一定作用。吸烟情况（P = 0.1122）、年龄（P = 0.9990）和假体重量（P = 0.1583）并非显著危险因素。重建效果92.8%为良好至优秀，患者满意度为非常满意至高度满意的占84%。
作者的系列研究表明，当设计合适的SRM模式时，直接乳房假体植入重建的SRM可以轻松进行，能提供完整的肌下-真皮-网片腔隙覆盖假体。
