From the Division of Plastic and Reconstructive Surgery, Mount Sinai Medical Center; and Orlando Health Aesthetic and Reconstructive Surgery Institute.
Plast Reconstr Surg. 2019 Jul;144(1S Utilizing a Spectrum of Cohesive Implants in Aesthetic and Reconstructive Breast Surgery):43S-50S. doi: 10.1097/PRS.0000000000005949.
Prepectoral breast reconstruction carries many benefits to patients, including its minimally invasive (muscle-sparing) nature, and its reduction in symptoms such as pain and animation deformity, relative to subpectoral reconstruction. However, without the traditional use of the pectoralis major muscle to mask the upper pole of the implant, and dictate the shape of the upper pole, certain steps must be taken to ensure the optimal aesthetic outcome in prepectoral reconstruction. Surgeons have utilized acellular dermal matrices, fat grafting, and highly cohesive implants to improve outcomes. Among the most important steps is the proper implant selection. To this end, the authors routinely utilize round form-stable gel implants, when performing prepectoral breast reconstruction. These implants offer improved aesthetic outcomes, given their ability to reduce rates of rippling and edge visibility. Furthermore, the characteristics of a soft and naturally shaped breast are achieved despite the lack of muscle coverage. The authors believe that reproducibly successful prepectoral reconstruction is dependent on proper technique. In this article, we present the proper techniques necessary for optimizing outcomes when using these implants in 2-stage prepectoral breast reconstruction.
胸肌前置乳房重建术为患者带来了许多益处，包括其微创（保留肌肉）特性，以及与胸肌下重建术相比，减少疼痛和动态畸形等症状。然而，由于没有传统的胸大肌来掩盖植入物的上极并决定上极的形状，因此在胸肌前置重建术中必须采取某些步骤来确保最佳的美学效果。外科医生已经使用了脱细胞真皮基质、脂肪移植和高凝聚力植入物来改善效果。其中最重要的步骤之一是正确选择植入物。为此，作者在进行胸肌前置乳房重建时，通常会使用圆形形态稳定的凝胶植入物。这些植入物能够降低波纹和边缘可见度的发生率，从而提供更好的美学效果。此外，即使没有肌肉覆盖，也能达到柔软和自然形状的乳房特征。作者认为，可重复成功的胸肌前置重建取决于正确的技术。在本文中，我们介绍了在 2 期胸肌前置乳房重建中使用这些植入物时优化结果所需的正确技术。
