Breast Center Salzburg, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria.
Department of Gynecology and Obstetrics, General Hospital Leoben, Leoben, Austria.
Breast. 2019 Dec;48:32-37. doi: 10.1016/j.breast.2019.08.002. Epub 2019 Aug 20.
Prepectoral implant placement is an innovative option for breast reconstruction, due to multiple advantages over subpectoral implant placement. The adoption of various ADMs and meshes supports the utilization of the prepectoral technique.
200 breasts were reconstructed with prepectoral implant placement after nipple-sparing mastectomy in a one-stage direct-to-implant procedure. The implants were completely covered and fixed with porcine ADMs (Strattice™ or Artia™), or with synthetic meshes (TIGR®). The pectoralis major muscle was not detached at all and kept intact entirely.
Minor complications included minimal nipple necrosis without further intervention and complete healing in 14 breasts (7.0%). Major complications comprised implant loss due to skin necrosis and wound infection in 7 breasts (3.5%), and hematoma with revision surgery in 8 breasts (4.0%). At a mean follow-up of 36 months cosmetic results were excellent and good in 180 breasts (90.0%), sufficient in 13 breasts (6.5%) and insufficient in 7 breasts (3.5%). Breast animation deformity and implant displacement could not be observed, while implant rotation was documented in 5 breasts (2.5%). Capsular contractures grade III or IV could not be observed neither in patients with previous radiotherapy nor in patients with radiotherapy to the reconstructed breast.
The single-stage direct-to-implant prepectoral implant placement after NSM with complete coverage of the implant with ADM or synthetic mesh represents a novel and feasible technique for breast reconstruction. This technique provides an alternative to the subpectoral implant placement with excellent cosmetic results avoiding the disadvantages of the subpectoral implant placement.
与胸肌下假体放置相比，胸前假体放置具有多种优势，是一种创新的乳房重建选择。各种 ADM 和网片的应用支持了胸前技术的应用。
在一期直接置管术中，200 例接受保留乳头的乳房切除术的患者接受了胸前假体植入。完全覆盖和固定假体使用猪 ADM（Strattice™ 或 Artia™）或合成网片（TIGR®）。胸大肌完全不分离并保持完整。
轻微并发症包括 14 例（7.0%）轻微乳头坏死无需进一步干预，完全愈合。主要并发症包括 7 例（3.5%）因皮肤坏死和伤口感染导致假体丢失，8 例（4.0%）因血肿需要再次手术。平均随访 36 个月，180 例（90.0%）乳房美容效果极好和良好，13 例（6.5%）乳房美容效果尚可，7 例（3.5%）乳房美容效果不足。未观察到乳房运动畸形和假体移位，5 例（2.5%）记录到假体旋转。既往接受过放疗的患者和接受过乳房重建放疗的患者均未观察到 III 或 IV 级包膜挛缩。
NSM 后一期直接置管胸前假体植入，完全覆盖假体使用 ADM 或合成网片，为乳房重建提供了一种新的可行技术。该技术与胸肌下假体放置相比具有良好的美容效果，避免了胸肌下假体放置的缺点。
