Gunnarsson Gudjon L, Thomsen Jorn Bo
Department of Plastic Surgery, Telemark Hospital, Norway.
Odense University Hospital and Lillebaelt Hospital, Vejle, Denmark.
Plast Reconstr Surg Glob Open. 2018 Oct 2;6(10):e1931. doi: 10.1097/GOX.0000000000001931. eCollection 2018 Oct.
Breast animation deformity has sparked a reappraisal of the prepectoral implant placement in breast reconstruction. Our approach for direct-to-implant breast reconstruction (DIR) has evolved from a dual plane muscle/mesh coverage to a simple prepectoral hammock covering just the inferolateral part of the implant without the muscle. The aim of this study was to test the procedure in a prospective case series with emphasis on reconstructive outcome.
Twenty-seven patients undergoing nipple- or skin-sparing mastectomy without subsequent radiation therapy requesting a primary implant-based reconstruction were included from May 2016 to April 2017. Median age was 46 years (25-67). We registered comorbidities, complications, and long-term results of successful or failed reconstruction.
Forty-seven DIR in 27 women, 20 bilateral, 7 unilateral. The median body mass index was 24 (17-31). The median time for mastectomy and DIR was 103 minutes (60-150). The inferolateral hammock consisted of Meso Biomatrix (34), Strattice (11), and Vicryl (2). The median implant size was 260 cc (140-345). Four complications (14%), 2 hematomas, 1 seroma, and 1 infection with partial nipple necrosis were all salvaged and reconstruction completed successfully. The median follow-up was 11 months (7-17).
The prepectoral inferolateral hammock, a swift one-stage procedure with a quick recovery, creates promising results in the presence of an adequate skin flap. The simplicity of the method has made it the authors first choice for DIR.
乳房活动畸形引发了对乳房重建中胸肌前植入物放置的重新评估。我们的直接植入式乳房重建（DIR）方法已从双平面肌肉/网片覆盖发展为简单的胸肌前吊床，仅覆盖植入物的下外侧部分而不覆盖肌肉。本研究的目的是在前瞻性病例系列中测试该手术方法，重点关注重建效果。
纳入2016年5月至2017年4月期间27例接受保乳或保皮乳房切除术且未接受后续放疗并要求进行初次植入物重建的患者。中位年龄为46岁（25 - 67岁）。我们记录了合并症、并发症以及重建成功或失败的长期结果。
27名女性共进行了47次DIR，其中20例为双侧，7例为单侧。中位体重指数为24（17 - 31）。乳房切除术和DIR的中位时间为103分钟（60 - 150分钟）。下外侧吊床由Meso Biomatrix（34例）、Strattice（11例）和Vicryl（2例）组成。中位植入物大小为260 cc（140 - 345）。4例并发症（14%），2例血肿，1例血清肿和1例伴有部分乳头坏死的感染均得到挽救，重建成功完成。中位随访时间为11个月（7 - 17个月）。
胸肌前下外侧吊床是一种快速的一期手术，恢复快，在皮瓣充足的情况下能产生令人满意的结果。该方法的简单性使其成为作者进行DIR的首选。
