From the Departments of Plastic and Reconstructive Surgery.
General Surgery, Akron City Hospital, Summa Health System, Akron, OH.
Ann Plast Surg. 2020 Mar;84(3):263-270. doi: 10.1097/SAP.0000000000002059.
Implant-based reconstruction is currently the most common postmastectomy breast reconstruction modality with over 86,000 procedures performed in 2017. Although various methods for reconstruction techniques have been described, partial subpectoral implant placement with or without acellular dermal matrix coverage remains the most popular approach. Recently, prepectoral implant placement has gained increased recognition as a method that avoids some of the potential morbidities of submuscular implant placement. Currently, few studies have examined the outcomes of performing this approach. The purpose of this study was to evaluate and compare the outcomes of prepectoral and subpectoral direct to implant (DTI) immediate breast reconstruction.
Data from a prospective cohort of consecutive patients undergoing prepectoral DTI immediate breast reconstructions at our institution from February 2016 to November 2017 were collected. The incidence of complications such as mastectomy skin flap necrosis, seroma, hematoma, infection, implant loss, and unexpected reoperation were recorded and compared with a cohort of consecutive patients who underwent subpectoral DTI immediate breast reconstruction from May 2014 to July 2015.
One hundred twelve prepectoral DTI immediate breast reconstructions were performed on 62 patients. Four breasts (4.4%) were diagnosed with infection. There were 8 breasts (7.1%) that suffered from mastectomy skin flap necrosis (5 partial thickness necrosis, 3 full thickness necrosis). There was 1 implant loss related to full thickness necrosis that required salvage with autologous tissue reconstruction. Prepectoral breast reconstruction had less esthetic revisions and comparable complications when compared with the historical subpectoral cohort.
When compared with the subpectoral DTI approach, prepectoral DTI breast reconstruction grants favorable complication rates and improved esthetic outcomes. Prepectoral DTI breast reconstruction is a safe modality that should be considered in any patient who is a candidate for immediate breast reconstruction.
植入物乳房重建是目前最常见的乳房切除术后重建方式，2017 年共进行了超过 86000 例手术。虽然已经描述了各种重建技术方法，但带或不带脱细胞真皮基质覆盖的部分胸肌下植入物放置仍然是最受欢迎的方法。最近，胸肌前植入物放置作为一种避免胸肌下植入物潜在并发症的方法得到了越来越多的认可。目前，很少有研究检查这种方法的结果。本研究旨在评估和比较胸肌前和胸肌下直接到植入物（DTI）即刻乳房重建的结果。
收集了我院 2016 年 2 月至 2017 年 11 月期间连续接受胸肌前 DTI 即刻乳房重建的前瞻性队列患者的数据。记录并比较了乳房切除术皮瓣坏死、血清肿、血肿、感染、植入物丢失和意外再次手术等并发症的发生率，与 2014 年 5 月至 2015 年 7 月期间连续接受胸肌下 DTI 即刻乳房重建的队列患者进行比较。
62 例患者共进行了 112 例胸肌前 DTI 即刻乳房重建。4 例乳房（4.4%）被诊断为感染。有 8 例乳房（7.1%）发生乳房切除术皮瓣坏死（5 例部分厚度坏死，3 例全层坏死）。有 1 例植入物丢失与全层坏死有关，需要自体组织重建进行挽救。与历史上的胸肌下队列相比，胸肌前乳房重建的美容修复更少，并发症相似。
与胸肌下 DTI 方法相比，胸肌前 DTI 乳房重建具有良好的并发症发生率和改善的美容效果。胸肌前 DTI 乳房重建是一种安全的方式，应考虑用于任何适合即刻乳房重建的患者。
