Wazir Umar, Mokbel Kefah
The London Breast Institute, Princess Grace Hospital, London, U.K.
In Vivo. 2018 Nov-Dec;32(6):1477-1480. doi: 10.21873/invivo.11402.
BACKGROUND/AIM: The recent development of acellular dermal matrix (ADM) devices has enhanced implant-based breast reconstruction surgery following conservative mastectomy for therapeutic and risk-reducing purposes leading to improved aesthetics. In the traditional sub-pectoral approach, coverage of the implant is provided by the pectoral muscles superiorly and the ADM inferiorly. The need to eliminate breast animation, reduce post-operative dysfunctional pain and the risk of capsular contracture, have stimulated surgeons to investigate the feasibility of placing the implant over the pectoralis major muscle with complete coverage with ADM thus inventing a novel pre-pectoral approach.
We reviewed the literature regarding this evolving technique of muscle sparing ADM-assisted implant-based immediate breast reconstruction. Also, we describe our technique, and present pictures of the post-operative result.
The early reported results of the pre-pectoral breast reconstruction approach are encouraging and confirmed the potential benefits of eliminating breast animation and reducing postoperative pain. However, most of these studies had a small sample size (<100 patients) and were retrospective in nature with a limited follow-up duration and lack of data regarding the objective aesthetic assessment and oncological outcome. Nevertheless, suitable patients undergoing conservative mastectomy and implant-based reconstruction should be offered this option while further evaluation is being performed.
背景/目的：脱细胞真皮基质（ADM）装置的最新进展改善了基于植入物的乳房重建手术，该手术用于治疗性和降低风险的保守性乳房切除术后，从而提升了美观度。在传统的胸大肌下植入法中，植入物上方由胸大肌覆盖，下方由ADM覆盖。为消除乳房活动、减轻术后功能障碍性疼痛以及降低包膜挛缩风险，促使外科医生研究将植入物置于胸大肌上方并完全由ADM覆盖的可行性，由此发明了一种新型的胸大肌前植入法。
我们回顾了关于这种保留肌肉的ADM辅助植入物即刻乳房重建的不断发展的技术的文献。此外，我们描述了我们的技术，并展示了术后结果的图片。
早期报道的胸大肌前乳房重建方法的结果令人鼓舞，并证实了消除乳房活动和减轻术后疼痛的潜在益处。然而，这些研究大多样本量较小（<100例患者），本质上是回顾性研究，随访时间有限，且缺乏关于客观美学评估和肿瘤学结果的数据。尽管如此，在进行进一步评估时，对于接受保守性乳房切除术和基于植入物重建的合适患者，应提供这种选择。
